This interview with Dr. Mary Claire Haver, a renowned menopause expert, discusses the often-misunderstood aspects of menopause, its wide-ranging health consequences, and the inadequate support women receive from the medical system and society. Dr. Haver emphasizes that while menopause is inevitable, suffering is not, and advocates for a more holistic approach to managing its symptoms.
Menopause is a multi-systemic issue: Menopause affects far more than just hot flashes and night sweats; it impacts nearly every organ system, including mental health, cardiovascular health, and musculoskeletal health. Many women experience depression, anxiety, brain fog, weight gain, and musculoskeletal issues.
The medical system is failing women: Dr. Haver criticizes the lack of education and attention given to menopause in medical training, leading to inadequate treatment and dismissal of women's concerns. She highlights the statistic that 85% of women experience menopausal symptoms, yet only 10.5% receive treatment.
Hormone Replacement Therapy (HRT) is often safe and effective: Despite misinformation from studies like the Women's Health Initiative, HRT is a valuable tool for many women and can significantly improve quality of life. Dr. Haver stresses the importance of starting HRT early in perimenopause to maximize its preventative benefits.
A holistic approach is crucial: Managing menopause effectively requires a comprehensive strategy that includes HRT (when appropriate), nutrition (focus on fiber, vitamin D, and protein), exercise (strength training), sleep optimization, and stress management.
Open communication is key: Dr. Haver urges women to share their experiences openly to reduce stigma and encourage better understanding and support from partners and healthcare providers.
Based on the transcript, Dr. Haver states that approximately 85% of her patients and women in menopause are deficient in Vitamin D, not just low. She also mentions that many women are deficient in fiber, with most getting around 12 grams a day when the minimum recommended amount is 25 grams. She doesn't explicitly mention other deficiencies in this section, but implies that magnesium is another nutrient many women are deficient in during menopause.
To address these deficiencies, Dr. Haver recommends checking vitamin D levels regularly and supplementing when necessary, as well as consuming foods rich in vitamin D. For fiber, she suggests increasing intake through fiber-rich foods like avocados, chia seeds, nuts, berries, and cruciferous vegetables. The transcript does not detail how to address magnesium deficiency beyond including it in her list of nutrients to focus on.
According to the transcript, local hormone replacement therapy (HRT) targets specific areas, like the vagina, using creams, rings, or other methods that deliver estrogen directly to the affected tissues. This approach minimizes systemic absorption, meaning it doesn't affect the entire body. Systemic HRT, on the other hand, involves methods like pills, patches, or pellets that distribute hormones throughout the body to address broader menopausal symptoms beyond localized issues.
Dr. Haver explains that local therapy, such as vaginal estrogen, is suitable for addressing genital urinary syndrome (vaginal dryness, recurrent UTIs), and is safe even for women with breast cancer. Systemic therapy, conversely, aims to manage a wider range of menopausal symptoms impacting multiple organ systems. The choice between local and systemic HRT, or a combination, depends on the individual's specific symptoms and health history. For example, women concerned about blood clots may prefer non-oral systemic options like patches or pellets, which bypass liver processing and reduce clotting risk associated with oral estrogen. The decision should be made in consultation with a healthcare provider.
The transcript mentions several potential side effects of hormone replacement therapy (HRT):
The transcript indicates that managing these side effects often involves adjusting the dosage or switching to different HRT delivery methods (e.g., switching from oral estrogen to patches or pellets to reduce blood clot risk). The specific management strategy would depend on the individual's response and needs, determined through consultation with Dr. Haver or a qualified healthcare provider.
Dr. Haver advises partners to approach the subject with love and sensitivity, avoiding diagnostic language. She suggests that partners should be observant of subtle changes in their partner's behavior, resilience, and ability to manage situations, using these as cues to initiate a conversation about the possibility of perimenopause or menopause. She encourages partners to normalize the conversation around menopause, reducing the associated stigma, and to help their partners find a healthcare provider to discuss their symptoms and explore treatment options. Ultimately, the advice emphasizes open communication, empathy, and a collaborative approach to address the challenges of this life stage.
In addition to the main focus on menopause, the video also covered these related topics:
The discussion around strength training emphasizes its importance in mitigating the negative effects of menopause. Dr. Haver highlights that women experience a significant loss of muscle mass during the first ten years of menopause (up to 10-15%), impacting insulin resistance, functionality (ability to recover from falls), and increasing the risk of osteoporosis. She stresses that the musculoskeletal unit acts as one; low muscle mass dramatically increases the risk of osteoporosis. Osteoporotic fractures are a serious concern, with 50% of women experiencing one before death, and often leading to significant pain, reduced mobility, and even death following a hip fracture.
Dr. Haver advocates for strength training to counteract muscle loss and prevent osteoporosis. She personally incorporates resistance training by using an incline treadmill, wearing a weighted vest, and doing weightlifting. She advises focusing on building strength over aiming for thinness, as muscle mass is a key factor in maintaining health and well-being during and after menopause. Furthermore, she mentions studies showing that creatine supplementation combined with weightlifting leads to significant gains in muscle mass and strength in older women, reinforcing the importance of strength training.
