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

Understanding the stages of a woman's reproductive life is vital, including the transitional phase known as perimenopause and the cessation of menstrual periods termed menopause. Dr. Mary Claire Haver provides clarity on these two stages, emphasizing the role of hormonal changes and advocating for a broader definition of menopause that goes beyond merely the absence of periods.

Menopause

Menopause is commonly defined as the cessation of menstrual periods for one year, but Dr. Haver criticizes this definition for failing to include scenarios such as hysterectomy, IUD use, ablation, PCOS, or other causes where women do not have menstrual periods. She suggests that the term "hypogonadism for females" could be more appropriate, as it encapsulates the complex endocrine interactions that occur with the decline of ovarian function, also known as ovarian senescence. This decline leads to a depletion of egg supply and a significant decrease in the production of sex hormones such as estradiol, progesterone, and testosterone from the ovaries.

Hormonal changes and ovarian function

Dr. Haver highlights that menopause signifies more than just the end of periods; it represents the conclusion of ovarian function and a downward trend in estradiol levels, resulting in women post-menopause having lower estradiol levels than those who are premenopausal. She underscores the need for more research into why ovarian cells become resistant to Follicle-Stimulating Hormone (FSH) during perimenopause and what happens at the receptor level, noting the disparity in research compared to other reproductive topics.

Perimenopause

Transition to menopause

Perimenopause is characterized as the transitional phase lasting 7-10 years before the cessation of menstruation, during which the regular monthly hormone cycle becomes erratic, leading to unpredictable menstrual cycles. During this period, the decrease in the egg supply reduces the effectiveness of the brain's si ...

Mary Claire Haver outlines the significant mental and physical health changes women undergo during perimenopause and menopause, emphasizing the importance of hormone therapy, the impact on sexual function, and the rise of cardiometabolic disease risk.

Perimenopause is associated with significant mental health changes, including increased anxiety, depression, and cognitive issues

The "zone of chaos" of hormonal fluctuations during perimenopause significantly increases the risk of mental health disorders, particularly depression. Haver points out that at least a 40% increase in mental health disorders can occur during this stage, with usage of SSRIs doubling across the transition. Anxiety symptoms heighten, executive functioning suffers, leading to ADD-type symptoms, and cognitive issues like "brain fog" become common. This brain fog extends to difficulties with word retrieval and performing calculations at work. Such severe executive functioning difficulties can result in one in five women quitting their jobs due to these symptoms. The fluctuations in estrogen and related neurotransmitters, such as serotonin, norepinephrine, and dopamine, are particularly disruptive, and Haver states that estrogen therapy may be more beneficial for women developing depression in perimenopause than SSRIs.

Fluctuations in estrogen, progesterone, and neurotransmitters like serotonin and dopamine drive these psychological symptoms

Haver explains that the fluctuations in hormone levels during perimenopause, which create a hormonal "zone of chaos," can considerably increase mental health disorders. These disturbances significantly impact neurotransmitters like serotonin and dopamine. Treatments that supply just enough estrogen to stabilize the hypothalamus without necessarily suppressing ovulation are critical for managing symptoms. Haver also mentions the correlation between hot flashes and psychological symptoms such as palpitations or an intense feeling of sadness.

Menopause leads to significant changes in body composition, including loss of muscle mass and increase in visceral fat

During menopause, Haver elaborates on the transition leading to an increase in the percentage of visceral fat — from about 8% premenopausally to 23% postmenopausally — without changes in diet and exercise. Such changes influence the basal metabolic rate and insulin resistance, thereby affecting the risk of cardiometabolic disease. The consequent loss of muscle and gain of visceral fat are almost universally experienced, with visceral ...

Andrew Huberman and Mary Claire Haver discuss ways to improve outcomes for those in perimenopause or menopause through lifestyle, diet, and resistance training.

Maintaining a healthy, anti-inflammatory diet high in fiber, protein, and phytonutrients can help offset menopausal symptoms

Mary Claire Haver talks about the importance of an anti-inflammatory diet to manage menopausal symptoms, mentioning her own creation, the Galveston Diet, which incorporates aspects of the Mediterranean diet, fasting, and is tailored to be palatable for Americans.

Adequate protein intake is crucial to preserve muscle mass and strength

Haver highlights the significance of protein in the diet, stating that women may need between 80 to 120 grams per day depending on their body composition. She references research suggesting that higher protein intake is associated with lower frailty scores in women. The recommended amount is around 1.5 to 1.7 grams per kilogram of lean body mass, which is higher than the general FDA recommendation of 0.8 grams. She also mentions the importance of spreading protein intake evenly throughout the day.

Regular resistance training is important to counteract age-related muscle and bone loss

Regular exercise, particularly resistance training, is emphasized by Haver as crucial for improving outcomes during perimenopause and menopause. She shares her shift in focus from being thin to improving bone and muscle strength, and she actively engages in resistance training three to four times a week. Haver encourages the use of a personal trainer to develop ...

Hormone replacement therapy (HRT), particularly estrogen therapy, has been highlighted as crucial for managing symptoms and reducing long-term health risks associated with menopause and perimenopause.

HRT, particularly estrogen therapy, can provide significant benefits for managing menopausal symptoms and reducing long-term health risks

Mary Claire Haver emphasized the essential role of estrogen in managing menopause symptoms. HRT doses, which were initially developed to stop hot flashes, are crucial to normalization of serotonin levels and stabilization of the thermoregulatory center in the hypothalamus according to both Haver and Andrew Huberman. In treating premature ovarian insufficiency, aggressive hormone therapy was suggested, which is about three to four times the amount needed by a reproductive-aged woman. Moreover, it was brought to light that the technology has been beneficial for issues like dry eyes, vertigo, and has consistently provided protection for bones, the genital urinary system, and skin.

It was noted that women on HRT combined with GLP-1 medication experienced a 30% increased weight loss, highlighting the interplay between estrogen therapy and metabolic processes. Additionally, the utility of progestin, particularly when administered orally at night, has been recognized for its ability to settle the brain and promote sleep, likely due to its effects on GABA.

The timing of initiating HRT is critical - earlier intervention (ages 50-59) provides greater cardiovascular and cognitive protection

The timing of initiating HRT was stressed to be critical, especially when HRT starts between the ages of 50 to 59, which is associated with a 50% decreased risk of cardiovascular disease, death from cardiovascular disease, and all-cause mortality. The American Heart Association corroborated this by finding that starting HRT in this age range significantly reduces cardiovascular complications. Estrogen's preventive capabilities, particularly in the coronary arteries, were highlighted by Haver, who also mentioned the importance of its anti-inflammatory properties.

HRT is not appropriate for all women, particularly those with hormone-sensitive cancers or severe liver disease

The conversation acknowledges that HRT is not suitable for all women. Women with a history of hormone-sensitive cancers, severe liver disease, or those currently experiencing blood clots should avoid HRT since estrogen is metabolized ...

Various treatments and lifestyle approaches are available to help manage menopausal symptoms, and while some have been studied extensively, evidence for others' efficacy remains mixed.

Certain supplements like collagen, creatine, and vitamin D may provide bone and muscle health benefits, but the evidence is mixed

Mary Claire Haver suggests there may be benefits of specific supplements for menopausal individuals. She discusses a cream with estriol for facial application, which may slow down the loss of collagen during the first five years of menopause. While Haver does not directly mention oral collagen supplements, she highlights a bioactive collagen that showed improvements in bone density in menopausal women with osteoporosis. Additionally, she speaks positively about Verisol, a supplement that might reduce wrinkles and cellulite, and Fortibone, which could improve bone density.

Haver also mentions creatine, recommending creatine monohydrate, specifically five grams a day, for muscle preservation based on studies in women. She adds that vitamin D is recommended for patients who are deficient and struggle with absorption.

However, Haver expresses skepticism about a new supplement called Equal, indicating the absence of robust studies supporting its use, demonstrating that not all supplements are backed by substantial evidence.

The discussion reveals alternatives to traditional hormone therapies, such as testosterone therapy, which has off-label benefits for bone density and muscle strength. This suggests a potential adjunctive use in managing musculoskeletal aspects of menopausal symptoms.

Lifestyle approaches like acupuncture, cognitive-behavioral therapy, and improved sleep hygiene can also help manage menopausal symptoms

Mary Claire Haver discusses the importance of lifestyle interventions in managing the symptoms of menopause. She emphasizes sleep hygiene, an important factor in symptom management. Haver notes that alcohol can impact the quality of sleep for menopausal women and advises reducing alcohol intake to avoid sleep disturbances.

She acknowledges that acupuncture may alleviate menopausal symptoms, althou ...