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Summary
On episode 641 of 40+ Fitness, Coach Allan sits down with Dr. Mary Claire Haver, a board-certified OBGYN, certified culinary medicine specialist, certified menopause provider, and founder of Mary Claire Wellness, a private medical practice focused on women in midlife. She is also the bestselling author of The Galveston Diet and, most recently, The New Menopause.
Dr. Haver explains why fewer than 10 percent of primary care providers are menopause-informed, why there’s no reliable blood test for perimenopause, and how the widely misread Women’s Health Initiative study led an entire generation of doctors and patients to fear hormone therapy unnecessarily.
The conversation covers when hormone therapy helps most, the real contraindications, and why women need to advocate for themselves, or bring an advocate with them, when a provider dismisses their symptoms.
Links
- https://thepauselife.com
- https://menopause.org
Key Takeaways
- Fewer than 10 percent of primary care providers are menopause-informed. Dr. Haver says most doctors were trained with the outdated notion that menopausal symptoms are largely psychological, so patients are often dismissed rather than properly evaluated.
- The five most common menopause symptoms go far beyond hot flashes. Fatigue, sleep disruption, weight gain, and musculoskeletal pain are all more common than hot flashes, but each has many possible causes, which makes menopause easy for doctors to miss entirely.
- There’s no reliable blood test for perimenopause. Hormone levels bounce around minute to minute during the seven-to-ten-year perimenopausal transition, so a single blood draw isn’t representative; postmenopause, by contrast, is easy to confirm with one test.
- The 1990s Women’s Health Initiative study was widely misreported. The estrogen-only arm actually showed a 30 percent decreased risk of breast cancer; the small increased risk seen in the combined-hormone arm was likely tied to the specific progestogen used at the time (Provera), not to estrogen itself.
- Starting hormone therapy within 10 years of menopause offers strong cardiovascular protection. Follow-up data shows roughly a 50 percent reduction in death from heart disease and all-cause mortality per year when started early; the benefit fades after age 60, though starting later isn’t necessarily unsafe if arteries and cholesterol check out.
- Losing estrogen without replacement roughly doubles or triples the rate of metabolic syndrome. Dr. Haver says this happens independent of any changes in diet and exercise, driven by estrogen’s role in how the liver processes cholesterol and manages insulin sensitivity.
- Hormone therapy has real contraindications that require ruling out first. Undiagnosed vaginal bleeding, active hormone-fed cancer, severe liver disease, and active blood clots are situations where a menopause-informed provider needs to investigate before prescribing, though many past blanket denials (like after certain gynecologic cancers) were overly cautious.
- Women can find a certified menopause provider through the Menopause Society’s website. Dr. Haver recommends looking for the certification checkmark at menopause.org to find a clinician trained specifically in this area, since even OBGYNs often lack this training.
- Dr. Haver’s three strategies to get and stay well: know your family history and risks so you can act ahead of time instead of reacting; prioritize nutrition and overall health over chasing thinness through calorie restriction alone; and build strength earlier in life rather than waiting, since starting to lift seriously only in her 50s meant less muscle mass heading into this stage of life.
“It’s the loss of estrogen and the time away from estrogen where we see the acceleration of these disease states.”
Dr. Mary Claire Haver
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Episode 645 – How to add muscle over 40 with Funk Roberts
Episode Notes
Podcast: 40+ Fitness
Episode: 641
Published: 2024-05-07
Host: Allan Misner (aka Coach Allan), author of The Wellness Roadmap
Guest(s): Dr. Mary Claire Haver, a board-certified OBGYN, a certified culinary medicine specialist, a certified menopause provider, and the founder of Mary Claire Wellness, a private medical practice that focuses on women in midlife, The New Menopause
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