The Real Truth About Menopause Treatments | Dr. Mary Claire Haver

Dr. Mary Claire Haver is board certified in Obstetrics and Gynecology and is a Certified Culinary Medicine Specialist from Tulane University. She is a Louisiana State University Medical Center graduate and completed her Obstetrics and Gynecology residency at the University of Texas Medical Branch (UTMB). She is also a Certified Menopause Specialist through The Menopause Society. Dr. Haver was a clinical professor at UTMB and The University of Texas Health Science Center at Houston. Dr. Haver has served as a Hospitalist, Associate Residency Director, and Assistant Professor in her career. In 2021 she opened Mary Claire Wellness, a clinic dedicated to caring for the menopausal patient. Dr. Haver developed The Galveston Diet, a three-pronged lifestyle plan that encourages fuel refocusing, intermittent fasting, and anti-inflammatory nutrition to manage hormonal symptoms, stabilize weight, and revitalize the body as it ages to provide benefits that will last a lifetime. Dr. Haver is working on her second book, The New Menopause, which will be released in the Spring of 2024.

In this episode we discuss:
– Is hormone therapy safe?
– Who is hormone replacement for?
– The top three tips to support your hormonal transitions.
– Which supplements you should use during perimenopause & menopause.

Chapters:
00:00:00 – The Inevitability of Menopause
00:05:01 – The W.H.I. and the Misinterpretation of Results
00:09:31 – The Link Between Progestogen and Breast Cancer Risk
00:14:24 – The Symptoms of Estrogen Depletion
00:18:44 – Hormone Delivery Options
00:22:55 – Hormonal Treatment After Menopause
00:27:35 – Progesterone and Estrogen in Hormone Therapy
00:31:58 – The Difference between Bioidentical and Synthetic Hormones
00:36:13 – Why isn’t This Standard of Care?
00:40:50 – The Complications of Menopause Treatment
00:45:28 – Hormones and Hair Loss
00:49:17 – What About Spironolactone?
00:54:52 – The Importance of Fiber and Vitamin D
00:59:15 – The Effects of Menopause on Body Composition
01:03:38 – Strength Over Skinny
01:08:27 – The Muscular Skeletal Unit in Menopause

This episode is brought to you by Paleo Valley, Air Doctor, LMNT, Inside Tracker, 1stPhorm

Order Mary’s New Book – https://www.amazon.com/New-Menopause-Navigating-Through-Hormonal/dp/059379625X/

Subscribe to the Dr. Gabrielle Lyon Show Podcast
Apple Podcasts: https://apple.co/3bdNr2h
Spotify: https://spoti.fi/39RC7Zk
Google Podcasts: https://bit.ly/3HLxlcz

Say hi on social:
Instagram: https://www.instagram.com/drgabriellelyon/

Sign up for my weekly newsletter:
https://www.drgabriellelyon.com

New patient inquiries:
https://drgabriellelyon.com/contact-us/

—
15% Off Your Purchase: https://paleovalley.com/drlyon

UP TO $300 off air purifiers!: https://airdoctorpro.com/drlyon

Inside Tracker 20% Off the Entire Store: https://info.insidetracker.com/drlyon

Get your free LMNT Sample Pack with any purchase: https://drinklmnt.com/drlyon

Visit 1st Phorm Website for Free Shipping on orders $75+: http://www.1stphorm.com/drlyon
—

Affiliate Disclaimer:
Note this description contains affiliate links that allow you to find the items mentioned in this video and support the channel at no cost to you. While this channel may earn minimal sums when the viewer uses the links, the viewer is in no way obligated to use these links. Thank you for your support!

Disclaimer: The Dr. Gabrielle Lyon Podcast and YouTube are for general information purposes only and do not constitute the practice of medicine, nursing, or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast, YouTube, or materials linked from this podcast or YouTube is at the user’s own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professional for any such conditions.

Going to replace estr and so I’m only having these discussions if a patient has an absolute contraindication to estrogen replacement and then we’re having to look for other ways to support her but remember ashwaganda is likely not going to support your brain or your bones or your

General urinary system it might help the PO flashes a little bit and maybe some brain fall and let’s mention one thing that I think is is crazy to think about is you is an individual could supplement with all of these things as long as they want

The reality is at some point a woman is going to go through menopause menop no amount of just right no amount of ashwagandha no amount of Chase treeberry no amount of any of these herbs uh vitamins minerals or nutrients are going to take away that biological change

Exactly um it’s just the way that it’s going to be right and we haven’t fig figured out medically how to stop that process and it begins at Birth thank you to paleo Valley for sponsoring this episode of the show eating right doesn’t have to be hard but you do have to be prepared this is one reason why I love paleo Valley beef sticks incredible one of my favorite snacks my kids love these their beef

Sticks are 100% grass-fed grass finished and are high in omega-3 fatty acids vitamins and minerals glutathione CLA and most importantly a source of bioavailable protein that taste great they ferment their sticks which creates naturally occurring probiotics which are not just great for muscle Health but great for gut health these taste

Incredible they are a great great snack for on the- go throw it in your bag take it on a trip there’s no excuse not to eat healthy the only excuse that you have is if you are unprepared head on over to paleo valley.com and use the code Dr lion for

15% off that is Paleo valley.com and use the code Dr lion for 15% off these incredible tasting beef sticks all right Mary CLA haer ha Haver I’m really excited to chat with you all things menopause this is probably one of the most requested and common topics

That we get over here and you certainly are the expert how long have you been in OBGYN um I started my residency in 1998 1998 So and I’ve been just focused on menopause care in practice since 2021 I opened my menopause clinic and then but I’ve really been just digging deep since about

Um about eight years so okay and it’s interesting that you say that you’ve really been digging deep because what that says to me is that in traditional OBGYN residency and teaching that potentially hormonal replacement therapy and and really managing hormones is not the standard of care in a way

That potentially would focus on optimization would you say that that’s right that’s 100% correct so in my roles um in my traditional OB gen career I was also a program director so I was in charge of the education of the residents for about 10 years off and on while I

Was delivering babies and teaching medical students and all the other things an academic Professor does and you know looking back on that that when we do Obstetrics and Gynecology we have probably 55 to 60% depending on the program is devoted to obstetrics which is important and everything else gets

Shoved into the Gynecology box so that’s going to include pediatric Gynecology Oncology so cervical cancer uterine cancer vulvar cancer um our reproductive Endocrinology so you know getting people pregnant some of the endocrine disorders associated with and then so menopause is just this tiny little sliver we did not have and there’s not many

Throughout the country menopause focused clinics it just kind of got lumped in with Gynecology in medical I think I had one hour of lecture if you had the same you know uh focused just on menopause and it was just the briefest overview and and then in residency it really was

Kind of we might have had six hours and four years of training of lectures devoted particularly to menopause and my last year of training was when the women’s Health Initiative was released which basically stopped the 90% of prescriptions for hormone replacement therapy for all women and it just left

This whole generation of women without the option of hormon replacement therapy let’s let’s talk about that the Women’s Health Initiative came out what 20 some years ago and probably 23 is a an example 23 years ago and that is an example of what really can change the narrative when something gets enough

Press and people don’t dive into the literature and question what is being tested and what is then being extrapolated about that can you mention a little bit about for our listeners who don’t know anything about the Women’s Health Initiative what it is what the outcomes have been and where it now has put

Us so um the women’s health health initiative was really exciting um we knew from anecdotal evidence and from observational studies that women who were on hormon hormone replacement therapy actually had a lower incidence of cardiovascular disease and death from cardiovascular disease we knew that their bones were stronger we knew that

Their General urinary systems would be more protected against um atrophy and other diseases associated with that but the focus of the study was really to see use a randomized like the gold standard randomized controlled Placebo controlled study um of thousands of women you know where they divided the women into

Hormone replacement therapy in the form of estrogen and progesterone versus placebo if they had a uterus and if they didn’t have a uterus usually because of hysterctomy they were given estrogen only with no progesterone um now we give progesterone it’s mandatory when you’re giving estrogen when you have a uterus because

It needs to protect the lining of the endometrium and it’s optional for women who don’t have it so that being clear so the study they recruit these patients there’s it’s a you know multi-million dollar study it’s the first we first focused on women in menopause true study

That had ever been done like finally we’re getting money devoted to us finally we’re you know and so when they chose the ages of patients the outcome of the study was not breast cancer occurrence it was heart disease that was what they were looking for breast cancer

Plus or minus was just a secondary finding and so that the average age of the patient the 63 years old in the study so it’s not your typical menopausal patient so they were taking women who at 63 average likely had already been on the path to heart

Disease or on the path to breast cancer and now we’re going to give them hormone replacement therapy and so they started recruiting patients I think in 1995 and I think the studies began in in the late 90s you know when they actually started giving them the hormones versus

Placebo and what they found found was in this particular population the women who were given estrogen plus progesterone had a relative risk increase of breast cancer of about 25% so they just the the the authors got together some of the authors not even all of them got together and decided to

Halt the study they held a press conference at the water date hotel in the ballroom invited every national news Outlet this is before social media right so this is in 2002 and said estrogen causes breast cancer all of the authors didn’t even have a chance to review the

Data the doctor you know like like we were getting phone calls like oh my God what’s going on because ABC News NBC News this was the biggest Health Report in in 2002 it was the number one news story for health and the headline screamed estrogen causes breast cancer

Well the estrogen only arm kept going because they didn’t have an increased risk of breast cancer they stopped it about two and a half years later and so but the narrative continued people were terrified you know now since that time there’s been multiple studies that have

Come out that have looked at the data reanalyzed it reworked it and we now know but it hasn’t been publicized which is just befuddling me that the women who were on estrogen only actually had a relative decrease risk of breast cancer and it seems like it was

The progestogen the pra that was the the link to to slightly increasing the risk so relative risk from you and I understand the statistics and they still I have to really think hard about it you know um doesn’t mean absolute risk and absolute risk was still very very very

Very very small and but everyone was so terrified including the Physicians because we weren’t even given the study to review on our own and it came out months later um but everyone was off and everyone was terrified and the narrative remains estrogen causes breast cancer I get questions on social media every

Single day my doctor says no my doctor says it’s going to give me a heart attack my doctor says it’s going to give me breast cancer we know that American Heart Association came out in 20120 saying women who start estrogen in you know estrogen replacement with without progesterone room it’s a protective

Effect so there’s something called the healthy cell hypothesis where is it called what is it the healthy cell hypothesis so estrogen isthis yeah estrogen is better at prevention than cure the longer your body is without estrogen either exogenous meaning hormone replacement therapy or natural the higher your risk

Of not only cardiovascular disease death from cardiovascular disease from um stroke from diabetes from hypertension from muscle mass loss sarcopenia from which we’re gonna talk about and um I mean it’s really astounding so when you have a very protective benefit of estrogen therapy when you start Young

When you start early in your menopausal Journey including per menopause thank you to air doctor for sponsoring this episode of the show I’m so excited to have partnered with air doctor I have been using Air Doctors for many years for air Health we talk a lot about

Exercise we talk a lot about nutrition but the air that you breathe and being in an environment that is free of allergens pollin pet dander dust mites mold spores sick building syndrome is a very real thing if you are someone who does not feel like they have the energy

That they should it potentially could be from your environment I love the Air Doctor it filters out almost all of the dangerous contaminants we’re talking 99.99% of contaminants Air Doctor does a fantastic job it has a 30day breathe easy money back guarantee if you don’t

Love it you can send it back for a refund head on over to airpro docomo Lion you’ll receive get ready up to $300 off air purifiers this is exclusive to my podcast listeners you will receive a free three-year warranty on any air purifying unit and that’s an

Additional value of $84 head on over to aird pro.com and use the promo code Dr lion you will be so glad that you did make sure you have one air doctor in your office and one in your bedroom and so can you can kind of touch

On um the age so basically when we think about menopause it’s this magical time that all of a sudden you haven’t had a period but per menopausal symptoms and probably the es and flows happen uh significantly earlier than that last period my biggest frustration is how we Define menopause it’s completely

Arbitrary in medicine that you must go A Year Without a period before your menopause your menopause ovarian depletion begins in your 30s and it may not be clinically significant until your 40s but your ovaries are not the same the the the we’re born with all of our eggs that’s

Just the way we’re made and that quality and quantity decreases from birth actually it starts decreasing in utero we have our Max ovarian levels of going seems like a little bit of a design flaw but okay right at five months in utero I can’t fix that you know and so at Birth

They start the function the quality and the quantity begin to decline our body doesn’t notice it until we reach a certain threshold so by the time that we are 30 we’re down to about 10% of our egg supply and by the time we’re 40 on average we’re down to about 3% and the

Quality of those eggs is declining rapidly and with that the quality of of our ovarian estrogen production is declining and because our bodies react so differently to estrogen decline where I might have H flashes Gabby you may have night sweats you may have sleep disruption I may have

Muscular skeletal issues you may have genital urinary syndrome we’ve I mean in my book we’ve identified about 70 symptoms associated with estrogen depletion and so the earlier we counteract this not only symptomatically the bothersome symptoms are going to get better but your he overall health status

Is going to get better as well I love that and uh again that is not routinely talked about and typically the standard is that what we hear about is you do not start estrogen specifically estrogen therapy until someone is in menopause that it some for some reason dangerous for a menstrating or intermittently

Menstrating woman to start estrogen and what I’m hearing from you is that that is in fact not what the literature says that is not helpful and in fact estrogen is protect Ive is there um so I guess for the clinicians listening so we have a whole range of individuals we have a

Lay public we have clinicians we have people that are just very astute in science would you say that there is a a starting dose I mean obviously we we look at Labs but have you found because you’ve seen thousands of patients have you found that there’s a starting dose

Potentially of astrad for women that they seem to do well with and and also what delivery system so um we don’t know uh I kind of there’s no studies right now that are looking at specifically per menopause and symptomatic control um we just really have antidotal and observational

Evidence and so here’s I can tell you what I do if a woman is still intermittently cycling or even if she’s cycling you know still having a monthly period but she is clearly symptomatic and I’ve done the blood work to rule out of conditions okay I’ve looked at her

Thyroid I’ve looked at her nutritional status I’ve looked at the labs I need to do to make sure that this is not masquerading is per menopause and it’s diagnosis of exclusion at that point a onetime blood test is not great at diagnosing per menopause and so I just

Listen to the patient and believe her okay I believe you so for those patients if she’s having heavy periods acne you know things that I think a higher dose are going to be well with controlling the heavy bleeding controlling the acne controlling you know some of the side

Effects I will go with a higher dose like in the birth control pill range of hormone therapy um because really the biggest difference between the birth control levels and the menopause hormone therapy levels is dose okay and the formulation is very different so we can talk about that later but when we look

At the Continuum birth control pills were developed to suppress ovulation so that she doesn’t get pregnant right menopause hormon therapy doses were developed to control half flashes basically where we need the levels for cardiovascular protection bone protection muscle protection those studies are kind of ongoing right now we

Don’t know there’s some pretty good on osteoporosis where it’s really really low but is that enough to protect your brain right so so we those studies you know are really kind of starting to explode right now and I’m very excited so if someone is cycling yet needs symptomatic control control due to other

Conditions I would go with a higher dose okay if she’s cycling and her periods are fine she feels fine you know other than disruptive hot flashes night sweats I may Shore her up with a very lowd dose estradi and for and 100 milligram oral micronized progesterone that’s my lowest

Dose that I’ll go with for that um I tend to stick with the FDA versions because of cost and I know they work and I know they’ve been studied I do go outside and um I will compound if they need it if I can’t find or try Doo they’re not

Tolerating progesterone the rare patient really struggles with progesterone so do is an FDA approved option non progestin um that they might tolerate but it’s very expensive or I’ll I’ll get I’ll talk to my compounder and get him to you know we’ll try some other options for there I do compound testosterone for my

Patients on a regular basis because I can’t find an FDA approved option that I can get a pharmacist to fill same um I love what you’re saying I love what you’re saying that basically the dose in a u birth control pill is really on the higher end and the doses

To control menopausal symptoms are on the lower end it’s probably somewhere in between and that that really hasn’t been the sliding scale which is which is fascinating have you found you know in my clinical practice we treat menopause and we do a lot of patches and things

And I really like the patch because it can be covered under insurance we do know that standardized do you have a delivery system and also the oral micronized progesterone do you like the patch as well versus potentially a cream I do um you know I I love the

Patch because it’s continuous dosing and they get this beautiful steady state so I feel like they’re covered I have five strengths that I can go to for her um and so if she’s super symptomatic and very early in her menopause I’m going higher dose patch you know is is where

I’m going to start the0 75 maybe the 0.1 the problem is it stops at 0.1 and I do have patients who need more so either we’re doing two patches and I’ve got to write a letter to the pharmaceutical you know to their insurance company which is

No problem that’s my job um or we might end in a very very small dose oral the reason why I tend to go towards the patch is when we ingest anything orally we have a first pass effect of the liver and when that estrogen hits the liver we

Do see a bump in and clotting factors and so eight out of 10,000 women will have a blood clot who would not have according to the latest research um and and there’s some pretty good studies that are showing that it lower the transdermal lowers overall inflammation versus oral now there are some benefits

To oral especially for in some small of the lipid numbers but it’s not you know when I look at the overall picture I really go towards the patch for the ma the vast majority of my patients now if she’s got allergic to the adhesive you know some patients have an allergic

Reaction to the adhesive then I’m I’m looking at compounding a cream or maybe trying oral for her and how long if the dose is high enough one of the questions that we get a lot is how fast should someone have resolution of symptoms if it is let’s

Say hot flashes mood brain fog how quick will we see a turnaround of symptoms so hot flashes the best I can go with because it’s really clear to you know Hot Fest is yes or no brain fog is a little tougher to to quantify um but hot

Flashes I will say if we’re not better in four weeks because I know it of course we always go to our own experience it was a solid three weeks for me I remember at week two going is this going to work you know do I need a

Higher dose and all of a sudden at week three I was sleeping through the night and so I tell my patients let’s give it four weeks you know we have to upregulate these receptors it’s a process it took you a while to get here it’s going to

Take us a while to fix it um and I know that when I went from I started on comi patch which I loved it was a great so convenient I didn’t have to remember to take anything and I you know a secondary pill but the study out of France they

Looked at 880,000 women and they looked at the different progestins and association with with neoplasia and the oral micronize progesterone had the least Association it was small but it was there and with so much cancer in my family I just thought you know I’m going

To air on the side of of being cautious here and um and I like having that bump of progesterone at night um so I switched to the oral micronized progesterone so when I did that I went from a comi patch the 0. five to a 0. five estradiol patch I started flashing

Within the month and so I always warn my patients when we’re switching from one modality to the other your body you absorb it differently like just be aware let me know what your symptoms are we may need to go up on your dose again or

Down and from a and from a safety stamp Point really the um the issue with oral estrogens is just that slight bump in clotting Factor now my I have a question for you and I think a lot of Physicians and and probably patients are also wondering this is they typically say do

Not start any kind of hormonal treatment therapy if you are 10 years postmenopause and the way that I read into that is um estrogen progesterone testosterone seems to uh Physicians will prescribe that whether they’re 10 years post or not but could you speak to where

The evidence uh of that is and if in fact you feel that that is a reasonable recommendation or we should reconsider that uh I definitely think we should reconsider it on a case-by Case basis and I don’t think it should be a blanket recommendation for everyone we know that

If you start hormone replacement therapy within 10 years of your menopause you will have cardiovascular protection and some neuro protection at least within five years from neurod dementia so um we lose some of that benefit as we age the longer your body goes without estrogen the higher these

Risks are going to go up and estrogen may not be helpful and in advanced cases of these diseases it certain forms of estrogen might be harmful and so again so when I have a patient who’s estrogen been menopausal for greater than 10 years and never had the benefit of HRT

Was never offered to her she was scared or you know very legitimate reasons but is curious and wants to know we look at her cardiovascular history her family history I get a full lipid panel I get apob I get you know I I try to dig as

Deep as I can I sometimes recommend a cardium you know if they if her levels are up we get a calcium score so a cardiac calcium score to see and if she’s low risk I’m like hey you’re probably going to benefit from this I can’t promise you anything the studies

Really weren’t done past this level but if I do know it’s going to protect your bones I do know it’s going to protect your genital urinary system it’s probably going to protect your muscles and several other organ systems and if you want to consider this I think it’s

Reasonable but again this is a caseby case basis same with neurod demen I have patients who have a very significant family history of of dementia young in their parents and who weren’t given the option and in are now 10 15 20 years past and we have decided for them that

It might be too risky because you know the benefit for neuro protection seems to be and that is their biggest fear you know what can I do so we’re trying to maximize nutrition I send them to Lisa Moscone you know to read her books on

The double x brain and and the uh her new books coming out the menopause brain which oh I’m so excited about and so you know so really it is a case-by case basis but I have patients absolutely that I have started on estrogen containing hormone therapy past

The age of you know past past 10 years postmenopause with all those boxes checked you know and knowing that we’re going to review this every year thank you to element for sponsoring this episode of the show I love element I love it because it keeps me well

Hydrated it helps me with muscle cramps fatigue you know sometimes I think I’m hungry but I’m actually thirsty and it is amazing to rehydrate with not just water because let’s face it when you sweat you are not sweating out water you need the sodium the potassium the

Magnesium and you don’t need any of the junk that’s exactly what element provides it’s formulated to help anybody and everyone with their electrolyte needs it is going to suit any diet plan it tastes incredible there are at least eight different flavors and depending on the season they also have certain

Chocolate flavors right now element is offering my listeners a free sample pack with any purchase that’s eight single serving packets free with any element order this is a great way to try all eight flavors and share it with your friends drink LM NT that’s drink element.com lion and this deal is only available

Through my link so head on over to drink LM nt.com lion and you will get a no questions asked refund if you don’t like it that means you can try it totally risk-free and could you uh where is the DAT where does the data stand right now should an

Individual you know because the the Women’s Health Initiative it seemed as if estrogen alone was okay where are we at now um do we never give estrogen without progesterone is it age dependent is it uterine dependent where are we at with the the combination therapy so combo therapy um you know

It’s mandatory with the uterus but if you’ve have a marina containing IUD so you have uterus is protected there or you’ve had hysterctomy which is a huge percent of of our patient population um is progesterone optional you know at first I said no no no you don’t need it

But you know as the literature is expanding and as I’m talking to patients and myself it’s very helpful for sleep it’s very helpful for anxiety especially racing thoughts at night so there are some benefits here to continuous progesterone um and so when I’m starting my patients you know I’m telling them

You know either we’re if they’re if they’re really sleep deprived I’m like let’s try this now we can always pull back or take it off you know but but there’s probably some benefit here that we haven’t recognized you know that where all this kind of involv involved

Was that estrogen was the hormone was the only thing we cared about right and we were just trying to stop hot flashes in menopause it really you know we really weren’t looking at everything else so women oh and that feminine Forever book oh my God who was kind of a

Get your sexy wait what is that the feminine forever I have never heard of that book oh my well we’re definitely reading your book but I I’ve never heard of feminine forever okay so the whole first wave of estrogen was this book by New York physician OB and it was called feminine

Forever and he was giving estrogen alone to everyone and man they were feeling great and it was kind of a get your wife back like the husbands were reading it and and they were and and look they weren’t having vaginal atrophy as much so women were going for it husbands were

Getting their wives on it all these women were just rushing to estrogen which had benefits and they felt great they were sleeping I mean yeah okay but you know the whole premise was really ick instead of from a health benefit it was this you know get your wife back in

Bed with you benefit um but what they found was a certain percentage of the population was developing an utal hyperplasia and cancer from unopposed estrogen well that’s very fixable by giving a woman with the uterus progesterone as long as you do that with the uterus you’re not going to increase

Your risk of inom matrial hyperplasia or cancer so so then it was like well only if you have a uterus do you need this progesterone well it has benefits and can can be taken very very safely um there are multiple progestogens on the market so so let’s kind of touch on that

So we have progesterone which is what our body makes naturally right and then we have progestins which are chemically synthesized in the lab which are converted to progesterones they bind to the receptor they actually work really great um but especially proa which is medroxy progesterone acetate that’s the

One that actually has a significant increased risk you know the absolute risk is low but there is an increased risk with Pera versus an oral micronized progesterone or some of the the transdermal proteses um that are safer and so in the Whi they only study two hormones Pro excuse me Premarin

Which is conjugated equine estrogen so they do some pretty sketchy stuff to pregnant Mars um pregnant horses and uht C their urine and and then there’s about 10 estrogen esque uh components to it uh so Prine was used forever that was the standard at the time it was not

Unreasonable for the Whi to use premine that was the number one prescribed um estrogen containing product on the market um and then the progesterone that they used was medroxy progesterone acetate it was cheap it was easy and at the time there wasn’t a progesterone that was easily absorbed through the gut

It had very low bioavailability so we fix that problem with the micronized progesterone they’ve micronized it it’s absorbed it works great okay but that wasn’t available when the Whi came out so it’s all very complicated and layered but you know the FDA is still lumping all estrogens into

One group and all progestogens into one group when really these risks are stratified based on which ones we take so in my practice and most people I know that are practicing good menopausal medicine we’re pretty much sticking to and progesterone we’re trying to keep it

As close to what the body made and it turns out that those have the lowest association with risk than the more synthetic options oh that’s interesting and what is the difference between bioidentical and synthetic so you have to think of it the way the body produces it um there’s a

Lot of misinformation and misunderstanding around the term body identical or bioidentical so in the UK they have body identical and bioid identical I choose to not go that that route here in the so we have things that are made in the lab um that bind to the same receptors as things that are

Processed in a lab but have but come from like a a more natural product so at the end of the day you have to go to the lab to make all this stuff you can’t I don’t care what that woman says you can’t just rub Gams on yourself and

Expect to have any clinical therapeutic benefits bless your heart if if you think that works for you but um you might turn orange but other that save save your money um it takes a lot of processing in the lab so so um yams are used to make the pro the micronized

Progesterone um but is a intense chemical procedure to get it to something that your body can absorb on a on a B on a basis synthetic means they just start with background chemicals and they end up with with something that will bind to an estrogen receptor those

Are not they’re that is ethanol estradi typically um which is works great um and is in most birth control pills and so we have millions of women year data on birth control pills and their safety and efficacy they’re getting kind of a bad WP I think for bad reasons but um but I

Used them for years I’ve used them for my patients to to keep them from getting pregnant to protect them from heavy bleeding acne different you know medical reasons and I stand by them to this day the ethanol estrad is not my favorite menopause hormone therapy does because

We don’t have any data on it um stick with estrad it’s it’s just really helpful to hear you talk about this and and break a lot of this down uh I know that everybody listening is going to want to have you back on um in terms of the changes that

Uh individuals expect to see in their Labs you know uh you had mentioned that you do a pretty robust cardiovascular profile you look at lipids you look at apob what are some of the changes and why when estrogen declines do we see these changes in lipid

Profiles um so we see a d pretty significant increase probably 80 75 80% of my patients will have an unexplained increase in their ldls and a decrease in their HDL so their protective cholesterol goes down and their their you know bad cholesterol including the the micronize particles go up um and so

It’s very frustrating for my patients they are Furious I’ve done nothing I’ve done nothing different I’ve not changed my diet and exercise I’ve been eating the same and there’s a huge subset of of doctors who are out there wanting to immediately put them on statins and I understand their reasoning for that but

When the American Heart Association said it loud and clear statins do not in a woman yes in a man they do help decrease their risk of cardiovascular disease and death from cardiovascular disease but they do not and a woman the most effective therapy for decreasing your risk of card cardiovascular disease and

Death is early hormone replacement therapy early an it’s the standard care right now right and it’s not the standard of care so uh women you will go and you will see these changes in lipids and you would think that the initial respon because the one thing that is

Different is the the decrease in estrogen but again that is not considered the standard of care which is a mistake it’s a mistake I think they aha clearly says it but all it takes so long for the standard of care to change and I’m not willing to wait I’m not willing

To let my patient suffer when I can intervene the best way I know how I love that about you Mary CL I just I just have so much respect for you um let me ask you this in terms of dosing um I’d love for you to speak on a

Way of thinking about it collectively so when we’re dosing estrogen are we also thinking about are we seeing an improvement in the lipid Pro profile are we seeing a particular change in FSH could you speak to that are we looking for that at a certain number what is it

You know as we’re guiding therapy assuming that a woman is beginning to feel better uh I have I can think of one patient she feels better on a very lowd dose estrogen and I’m continuously encouraging her to potentially increase her dose because I’d like to see a

Change in her lipid profile but um we’re not there yet so I’m curious as to where you look for particular markers specifically um not insulin FSH these lipid profiles yeah so I’m not I’m not following FSH long term in my patients symptomatically I’m following symptoms

Does she feel better Etc like you I use a toolkit when I’m treating my patients and so hormone therapy is one small tool in the toolkit we are going hard on nutrition hard on exercise hard on stress reduction hard on sleep optimization all of this must work together if I’m just

Relying on hormone therapy I’m doing a disservice to my patients and so when I see a resolution and supplementation so when a patient comes in with elevated cholesterol I’m talking about increasing fiber in her diet considering something like berberine you know we we take a look at her nutritional profile we look

At exercise we look at um her sleep patterns you know and then we’re following the lipids throughout overall and then so I’m at this point I haven’t again my P my clinic started in 2021 so I’m only we’re at year two right now and um I haven’t increased estrogen

Dose based on lipids yet I have seen a dramatic Improvement but it takes the toolkit you know it’s not just a te yeah um you know I haven’t either but I I always think you know is there a way that we could better Target just these cardioprotective um mechanisms with very

Specific dosing or levels and again it’s interesting you don’t follow FSH uh and I think that that’s very telling for a lot of people that it it truly is about how the individual feels and then um potentially secondary outcomes or a secondary markers that we’re looking at do you look at progesterone estrogen

Ratio there’s a lot of discussion about that do you look at these ratios no yes I don’t either finally somebody says no I talked to a lot of experts and they were always always I’m like no my God no feel very um listen I I feel uh very

Supported in this moment because uh people will say well don’t you look at these ratios I’m thinking first of all the half life of what day of the cycle are you you know if they understood anything about ovarian endo ology so so the term estrogen dominance has become a

Darling of profiteers who are stepping so far out of the scope of their practice and really are we’re laughing I’m laughing because it’s so true it’s so true leveraging pseudoscience to sell whatever supplement they’re trying to now this is a doctor who sells supplements right here so full

Disclosure I it just befuddles me like that and God bless these women we have this entire vulnerable subset of our population which is every single woman over the age of 35 who doesn’t know where to turn who is desperate who is miserable who is suffering who is on this path to an

Earlier death with lower quality of life who is just trying to do her best who is falling prey to this and I am sick of it I’m all for we’re all learning Gabby I learn from you you learn from me I mean this is the wild west okay but there are

Practitioners out there who are talking the most nonsense nonsensical and at this point I am not checking estrogen progesterone ratios I just treating the patient I know what’s happening and I her and treat her sorry I’m so listen I think this is what this this really

Comes down to is that um you know there’s all these complicated protocols if people are making it really complicated and I think that I’m speaking to both the provider and the patient if you are going to a provider that is making things incredibly complicated changing your dosing every

Third day all of these weird protocols then I in my professional opinion this is not the right provider things do not have to be complicated to be effective you don’t need these very fancy ratios you do have to understand what are your Baseline levels how are they improving

How is this person feeling um and uh I absolutely agree with Mary CLA there’s a lot of um predatory esque behavior po potentially very uh well-meaning individuals that are creating a narrative that is ultimately confusing and very poor science and that is not intellectual Har have to understand that

I think it’s very harmful expensive let’s be frank and menopause care doesn’t have to be complicated or expensive yes yes let’s talk about hair loss and per menopause or menop hair can we talk about that please what what is a woman to do what are some of these treatments are we talking about

Minoxidil are we talking about topical um are we talking about spironolactone what is a woman to do when all of a sudden she runs her hair through her formly gorgeous locks and all of a sudden the drain is clogged and it looks like there is Mr

It right so there is an aging component to hair loss that you know we’re getting older and our hair follicle structure is changing but there’s definitely a hormonal component as well there’s a nutritional component that could be there vitamin deficiencies can cause it um hyper hypothyroidism can cause it

Like hair loss is complicated so one you know your physician should dive in to make sure we’re not missing something else and there could be you could have multiple things that are causing this for you right um it may require a visit to a dermatologist there’s also infections and autoimmune disease and you

Know the list goes on and on so make sure that you’re not rushing you know I think it’s okay for most people to try on an exadel over the counter it’s not harmful the topical um and then if that’s not helping you need to get into c a specialist um someone who who

Like you and I who kind of dive into this or a dermatologist to help rule out some of other conditions Okay so and I and I you’re talking about sorry we guys we have a little bit of a delay in case you guys are hearing this on on the opposite end

Yeah go ahead so so go see someone who has some expertise in this area um but don’t let them blow you off and say well there’s nothing we can do because there’s absolutely stuff that you can do so um you what I wouldn’t do is rush to

Do like PRP or any of these really expensive therapies and treatments until we know what’s causing it because this may not be that helpful to you and you may it may be a simple vitamin deficiency that needs to be corrected so so make sure that you know your vitamin

D levels are adequate you don’t have an iron deficiency both of these are kind of the top two nutritional things that I go do a deep dive for there um do we all need the expensive $90 a month vitamin I don’t think so you know I think it’s oh

You do $90 no I’m kidding I’m kidding I’m kidding uh see my my mom jokes are my mom jokes are coming in hot with the delay and I just want to mention I want to piggyback off of what she had mentioned iron totally agree um fertin I

Think I’d like to see above 75 certainly for hair growth H and we check a cerula plasma we check a a form of copper in the blood and that definitely can relate to hair loss but I just wanted to mention that and uh was sad about my mom joke falling

Flat um so so um and then hormonally what can we do so there are hormones that can contribute to hair loss when you receive excessive amounts of it or so we have to talk about steroid hormone binding globulin so shbg is a protein created in the liver and it is

The car that our sex hormones ride in when they float through the bloodstream okay and when they’re in the car they’re inactive they don’t work very well um but they’re they’re just bound you know so they can float around so your overall levels may not change but your the

Activity of those levels may change so testosterone is bad for hair for female because High the higher your testosterone level three the more likely you are to have acne and male pattern baldness and you know attaching to the you know so this is the hair loss here

On the sides typically um when your parts getting wider in the middle that is more of a female oh God my hair a female it’s very dry here a female pattern type of hair loss thank you to insid tracker for sponsoring this episode of the show inside tracker is an

Incredible service that allows you to see what is going on within your body we must be able to look at data points it’s not just about how you feel but it is about where is your insulin where is your iron where is your apob these are all markers that are available through

Inside tracker and tell us very important information about how you are doing go to insid tracker.com Lion my listeners get 20% off the entire insid tracker store it’s incredible inside tracker analizes your blood your DNA syncs with your Fitness tracking data to identify areas where you can improve if you guys

Have not gotten your yearly blood work you know that I recommend at least at least once a year you know what is happening so if you are on the fence and you have not done it head on over to inside tracker.com lion and you can choose from

A full array of products so and those are treated very differently so if you are someone who is noticing new this male pattern here which happened to me a little bit and for those of you who are sorry and for those of you who are not watching and listening she’s uh

Addressing her temples so basically m a male pattern baldness would be the the temple uh recession and by the way I will say some individuals are sensitive to testosterone whereas other women you know I have women on testosterone they are not sensitive at all maybe they have

Low DHT receptors but you guys it you will know nearly IM immediately if you are one of those individuals and she was also mentioning the top the widening part that’s female pattern boldness right in general yeah and you can have both so um so when I have a patient who comes to me

Or she’s on testosterone and she’s seeing some loss here we’re going to try to decrease that dose okay when we go through menopause our estrogen levels Decline and estrogen kind of stimulates the production of that binding hormone so we see more activity of our androgens and so just going through menopause can

Contribute to male pattern bonness because your testosterone level hasn’t changed that much and it may have even declined the overall level but the activity of that level has increased and if you’re one of those women who is sensitive to the DHT or has high DHT receptors then you’re going to see that

Acne is another thing uh the you’re growing hair where you don’t want it and you’re um she means Chin Chin the stray eyebrow hair on your chin let me ask you this would do you ever recommend spironolactone because i’ I’ve looked in the literature and I feel extremely torn

About it I’m G to tell you why so you can really help redirect my thinking um so spona lactone has been used at 100 to 200 milligrams for acne for hair loss and I in the literature it seems mixed so some of it we’ll say it is um Prim

Arily addressed in The receptors so whether it is and it doesn’t have a significant systemic response because the last thing that I want to do is tank someone’s testosterone testosterone um so I would love for you to educate me is it okay will it reduce a woman’s blood level of testosterone where potentially

She might have an impact on her sex drive Etc versus just her hair or skin so again the jury is still out on we know it helps with acne and we know it helps with with hair loss but at what cost and so you might be sacrificing

Your desire and drive um because we are lowering the activity of the Testo you the ability of testosterone to bind to the receptor we’re not sure it doesn’t seem like it’s lowering your blood levels of testosterone it’s lowering its ability to function and so women on long-term spol lactone so Kelly

Casperson with you are not broken is really my kind of go-to for this kind of stuff and we’re seeing like clitoral Atri y decreased sensation in the area on women on long terms spironolactone and so for those patients who are doing well on it otherwise they’re using topical testosterone to

Try to build that you know in the clitoral area in the vulva to try to help build that tissue back up but again you’re you’re like fixing you’re robbing Peter to pay Paul in some of these conditions so now I’m moving more towards an oral minoxidil for my

Patients um what do do you like to to utilize oh so the studies have gone up to five I’m a little scared so I start weuse I can share we we start low but we typically land on around three milligrams for women okay we have something new that I’m trying because I’m I’m

Getting you know so many of my patients are ending up on testosterone due to not only the the the sexual Wellness benefits but the the Sleep the mental de Clarity you know the brain fog it seems to be helpful across the board and I am just going right off

You know I’m going off the off off the recommendations and I’m using it for my patients who have low muscle mass I’m going I’m going for it so um I have an ability in my clinic to measure muscle mass I we’re I can’t afford the dexa yet

Getting there but I’m do I have the inbody scan I have the medical and so I feel like it’s a pretty good um substitute for aexa and when I’m seeing their muscle mass ranges less than 90th percentile I’m you know off label recommending testosterone for that as

Well I full dis I wasn’t on it okay I I’ve lived I’ve been skinny my whole life I don’t have high muscle mass and I’m fighting fighting fighting and I was like you know what I’m gonna try it added benefit did not expect my drive to

Increase I didn’t think I had a problem I thought we were okay we’re just the normal married for 30 years couple and um H seems like there’s a little more interest in that area at our house and everyone’s happy so I was like it was

Like a a bonus you know I I would not have classified myself as H hypoactive sexual desire disorder no one is swinging from the chandeliers at my house but and yeah so that has been something I didn’t realize and so I tell my patients this you know um and everyone’s happy

So I I absolutely love that and I think eventually for muscle mass they are going to make something called a D3 creatine available and it’s a deuterated creatine you’ll take a pill you’ll pee it out you’ll be able to measure it you’ll be able to actually see exactly

How much muscle mass an individual has um and it’s been validated it’s just not available yes yes it’s just not um available to practitioners yet and I’m I’m really hoping that it will be in the next handful of years because that would be extraordinary what about supplementation do you think that

There’s evidence to certain supplementation I think for a very long time people would talk about black cohos they would talk about chiandra Berry is there evidence to support utilization or treeberry exactly so when I have my toolkit for my patients and we’re looking across the Spectrum we’ve got to stop defining

Menopause by hot flashes and night sweats I’m looking at her whole I’m looking at every organ system for her so when I’m talking about supplementation and what’s what estrogen deprivation is doing to your body Number One supplement is going to be F you know women are on The Struggle

Bus trying to get adequate am amounts of fiber in their diet per day the average American woman is getting 10 to 12 and we have showing Fiber One it decreases the absorption of the rate of absorption of glucose into our bloodstream so it’s going to stabilize our insulin levels

Better number two it feeds our gut microbiome and if you’re not paying attention to the studies exploding around the gut which was completely dismissed 10 years ago and now it’s everything the health of our gut microbiome and how important it is to our mental health how our heart

Functions you know the gut microbiome approaches that of a man when you go through menopause it totally changes you know the microb actually did not know that I had no idea yes so I potentially have a male gut microbiome I’m just kid if you don’t replace well oral you know

Oral estrogen this is one of the places where oral estrogen might be better than than transdermal we need a lot more studies you know I can see a a point where we have some very lowd dose oral estrogen with some transor you know we just need where I really see it going is

We just need to extend the shelf life of the ovary we got to figure out how to do that people are working on that um that’s the best way um but estrogen maybe a little bit better for the microbiome because that’s where it’s heading you know that’s where it goes

First and and there are an estrogen in the gut does change things and so you know I’m not on it for that reason I’m doing everything else to support my gut um so fiber okay I go off on so many tangents I love all that stuff um and

Then I’ll you I’m Gonna Keep you uh on the tight and narrow um I think that I think number two supplement is vitamin D vitamin D 85% of my patients are deficient in vitamin D that hormone has receptors in every organ system of our body it’s just it goes hand inand with

Estrogen and so you can safely supplement without worries of toxicity though you may need more 4,000 international units a day so my supplement I created for my patients and followers has 4,000 IU I’m going to push it to the highest level that you can do safely we throw in some omega with it

And vitamin K for absorption and so that I think most women should be on it’s almost impossible to get it naturally at our age due to decreas absorption through the gut it is the rare patient I see who without supplementation has a normal vitamin D level

Um vitamin D helps with sleep helps with cholesterol helps with all the things so we got to start with the basics um as far as you know the claims of you know ashwaganda and all these phytoestrogens phytoestrogens can be helpful but when the randomized control studies were

Looked at versus placebo it’s just kind of mixed you might have the anecdotal patient who sees some relief but it’s not going to replace estr and so I’m only having these discussions if a patient has an absolute contraindication to estrogen replacement and then we’re having to look for other

Ways to support her but remember ashanda is likely not going to support your brain or your bones or your general urinary system it might help the pot flashes a little bit and maybe some brain fall and let’s mention one thing that I think is is crazy to think about is you

Is an individual could supplement with all of these things as long as they want the reality is at some point a woman is going to go through menopause no amount of just right no amount of ashwagandha no amount of Chase free Berry no amount of any of these herbs uh vitamins

Minerals or nutrients are going to take away that biological change exactly um it’s just the way that it’s going to be right and we haven’t figured out medically how to stop that process and it begins at Birth you know and so so we one we have to stop defining I

Have so many sweet patients or followers who are like but I never went through menopause I didn’t have any hot flashes you know we have to stop defining my periods just stopped I’m like well great you know the lower super flashers have higher risk of cardiovascular disease and neurod dementia so that’s wonderful

For you but it doesn’t mean that in the background your cholesterol profile is not you know starting to tank you’re losing muscle mass I promise if you’re not doing something about it you are you know all of these things are happening that are contributing to your decline

I’m not saying you’re never going to die but I’m saying that you want those last 10 years to be as functional as possible and if you’re not paying attention to what menopause is doing to your body you’re going to suffer more than you needed to yeah um absolutely true do do you see

That when women now I know that this is not a treatment for body composition changes is hormonal replacement therapy it just current is not do you see a change in the positive when individuals are going through param menopause or menopause and they begin hormone replacement therapy do you see an

Alteration and Improvement in body composition with estrogen progesterone testosterone I do absolutely do again I have a machine to measure it um now again we all are also addressing nutrition and all the other things in the toolkit so but we I am seeing dramatic decreases in fat with my

Patients and it’s it’s I don’t know what’s the biggest factor for them and again we have individual genetic Expressions here and we’re treating everything that we can at once um but we know from observational studies that women who were given the option of HRT early especially in perimenopause

Through their transition and into full menopause have lower visceral fat than women who were not where do you the future where do you think the future of menopause uh and hormone replacement therapy is going so many ways um I think I hope that we are going to

Have more Ops for patients as far as dosages and Delivery Systems what I would love to see is a vaginal ring that is Affordable that contains that we have an estrogen progesterone and testosterone option I guess number one is an FDA approved option for testosterone for

Women and I think that the safest and most the problem with progesterone as it is progesterone in its its natural form is the best way to give it to your body as as far as we can tell and we don’t have a great nonoral option for that yet

The progesterone molecule is huge and it’s really difficult to get it to pass through the skin so until we can find a micronized way to get it through the skin and get it to a sustainable level then we’re going to have to go with oil

So so I think the first step is an an an affordable estrad ring because really we’re treating the vagina the general urinary system and systemically all in one so you don’t need a separate vaginal cream um and then getting an F I think top priority is getting an FDA approved

Testosterone option for women that’s going to be number one and then getting it into more formulations so we have more options to offer patients that are tolerable to them and getting way more studies on other organ systems out outside of just T flashes um and seeing what are the dose optimizations for that

We don’t know yet I know isn’t that isn’t it amazing that in 2023 2024 we still don’t know optimal dosage for different organ systems I mean it is pretty mindblowing we’re guessing when you know we’re guessing um it’s just it’s wild when you think about training and

Exercise do you find that women seem to respond better to high-intensity interval training or strength training obviously many people have continued to do cardiovascular activity but do you find that in your clinical practice there’s one way in which people really move than need all uh it’s got to be strength training

But it’s really hard there’s so much noise out there as to what’s optimal there’s so many predators out there who are praying on these poor women um who are are you know they go in armed with everything I told them and then these these trainers are trying to negate

Everything I said and um and women are it’s so hard to let go of the skinny is the is where I’m heading you know strength over skinny is a really hard concept for people to given all of the lifetime of the mental Beatdown on the number on the scale

Being the most important thing I can’t tell you the joy I have in some of my patients when I tell them that they’re not obese they’re just have a lot of muscle you know and we don’t even discuss their BMI I never talk about BMI and we talk about muscle mask we talk

About fat mask we talk about viseral fat and so you know getting them to let go of burning calories as much you know of being strong over skinny is really tough and the women who are able to cross that bridge and and embrace that we’re seeing the biggest Health

Gain yeah what is the and obviously I completely agree with you I wrote a book called Forever Strong which is all about that skeletal muscle is the organ of Longevity if you were to leave people with three pieces of advice for per menopause menopause please tell me I

Know it’s only three oh and by the way after you leave me with those three I want to talk all about your new book because I cannot wait to get a copy I’m still waiting for my copy by the way um we I’ll be sending you something

In the email very shortly um number one menopause is inevitable suffering is not so we don’t have a consistent way to train our healthc care providers as to menopause care all I can do is arm you with things to advocate for yourself with evidence and data to advocate for for yourself

And at least point you in the direction of clinicians we know have been helpful to other other of my followers or those certified by the menopause society which is not a guarantee on either direction but it’s somewhere to start you cannot assume that the wonderful OB Jen who did all your well

Woming care and delivered your babies and you know contraceptive management and took care of your infections and everything is going to have a clue or any time in their schedule to really devote themselves to menopause care it’s almost impossible because I was that doctor for a long time and full

Disclosure I was a terrible menopause provider for 15 years terrible I’m ashamed but I didn’t know what I didn’t know and I’m here to fix it and you may have some well-meaning provider who is still stuck in the 2000s as far as what they learned about menopause and I’m calling out clearly

The American Board of OB Jen because they are not putting for our yearly certification exams hardly any data for menopause studies to help us as a group of certified OB Jens stay up up to date with the latest research they’re just not doing it not in

2023 that’s important where do you go to vitamin D and fiber nutrition first thank you to first form for sponsoring this episode of the show you should support your foundational Health one way to do that is yes diet and exercise another way to do that is to

Give your body an effective dose of a essential vitamins minerals and nutrients so that you have great energy levels good immune Health a good metabolism heart brain function and all of the things that is why I love micro Factor it comes in a very easy to travel

With which this is important because we are all so busy and when I say travel doesn’t mean you have to get on a plane but if you are running to the gym or running to the office first form has a great little pack that has antioxidants CoQ10 essential fatty acids and a fruit

And veggie tab a multivitamin all of the things that you need to live a healthy life they’ve done a fantastic job at putting together this formulation head on over to First form.com Dr lion and you will get free shipping in the US for orders of $75 or more very important do you prioritize

Protein I know there’s a little delay I do now I do now so it was not I mean it was important but as far as making it the top thing that I’m trying my goal that I’m going to hit for prioritizing it in my meals this is something I’ve

Been doing since following you and I’ll be honest my daughter who’s a nutrition science major is the one who made me start following you and so she found you first she’s now in medical school by the way and absolutely you have got to follow this woman so

That is how I found you she was sending me all your videos and and so it really helped me refocus my thought process on how important the muscular skeletal unit is in menopause and um and how we could just just a few simple changes just increasing that um

Level of protein intake can do so much good for a woman especially our age yes that’s so so wonderful um tell me about your new book tell me all the details I cannot wait to share it with my audience my first book was gison diet

And you know named after my home and it was nutrition and wellness program for women in midlife and menopause um but that book kind of exploded the conversation where people were like yeah that’s fine but but tell me more what about this frozen shoulder what about this vertigo what about all these other

Symptoms and it just took me down these rabbit holes and I realized there’s a lot more information I left on the table as far as the medical aspects of menopause and I feel like there’s a there’s a gap in what’s available and I I I can fill that Gap with another book

So the book is called the new menopause and it’s really something I hope gets into the hands of everyone 35 and older who is struggling or the loved ones you know to help them understand understand this process and what their loved one is going through and how they

Can be supportive so the first part is all about the history of menopause and kind of how we’ve gotten to where we are why women are dismissed why we don’t have lack of train you know what’s going on in society as far as our views of how

Women Age and and what our places in society are and then I get into the the medical aspects of menopause what it actually is as far so that everyone understands what’s happening to the ovaries and organ systems when we lose estrogen progesterone testosterone and then we talk about medical hormone

Replacement therapy what options are available I do a deep dive in that so patients feel like they can have a conversation with their Healthcare Providers and then the last section is going organ system by organ system what menopause can do brains bones kidney lungs vertigo dry skin hair teeth na

Everything and what what the data has shown us so far and where the gaps are and so what HRT might be helpful with what other things you can do supplements nutrition exercise sleep what we know that they help with and so at least you have a starting point and we’ve turned

In a manuscript and I could probably write eight more chapters but we had to stop somewhere I’m sure you felt the same way with your book so it’s really a labor of love and it’s really just a compilation of everything I talk about on social media every day in a readable

Format and when is it out and where can people get it so uh it will be released April 30th and it’s available for pre-order Now everywhere you buy books so Amazon Barnes & Noble you know wherever you buy books you can find it and pre-order and and I I just want to

Mention to all my listeners is that the pre-order really helps the author um so please if you found this valuable I love Mary CLA I think she’s wonderful I am going to be ordering a handful of copies for myself and again it takes a lot of

Effort and energy to write a book and when we pre-order the book it really really helps the author so let’s all give her support and do that Mary CLA pver thank you so much for coming on and I’m very excited to share you with my audience you are really an advocate for

These changes for women and um I know that it’s not always easy and it certainly is not always easy being in the public eye and being in social media and on social media you are doing a wonderful job and everybody needs to hear what you have to say and I’m so

Grateful for you thank you so much and right back at you if any of my followers are listening please follow on social media her book is fantastic such wonderful way to think about strength and Longevity and please please please support her by um buying her book as

Well you guys better be getting my book um until the next time everybody thank you so much for joining Us