The MENOPAUSE Message with HORMONE EXPERT Dr. Mary Claire | More Thank A Pretty Face

core of her research is Alzheimer's and Dementia and why women are affected at such a higher percentage than men and it's not because we live longer but really those changes are are you begin to see those changes starting out in the per menopause transition so really this should be addressed before you completely run out of don't wait until you're in your 50s to address these changes well welcome to the more than a pretty face podcast where we go more than skin deep into the science of beauty health and wellness so you can feel your best at every age I'm your host Dr Oz shirazi and today we're going to be talking about menopause and Par menopause and hormones and how that affects your skin but also your entire body and it's a must listen for every woman out there I'm so honored to have have the nation's leading expert on menopause and per menopause joining us today on the podcast so that our audience really learns how to navigate their hormonal climate throughout their life because as you guys may know menopause hits you at right around age 51 but the symptoms of Perry menopause can start as early as in your 30s and Dr Mary CLA is going to go into detail about that but I think this is such an important topic and something that many women are not aware Because by the time you hit menopause in your 50s or in your early 50s you may have missed out on a lot of the benefits that you could have received starting hormones sooner than that and I'm so excited to have a board certified OBGYN and menopause hormone specialist on the podcast today so that our audience can be better informed at navigating their hormonal climates through every decade of life from galvaston Texas Our Guest is joining us she is not only a board certified OBGYN but she is also a bestselling author and the creator of the Galveston diet which I'm so excited to hear about she has dedicated her career to empowering women to learn more about their hormones in order to improve the quality of their life please help me welcome Dr Mary Claire Haver hi hi so happy to be here love sharing the menopause message I know and I'm so inspired by you you know I feel like traditionally even as a physician we never got the proper training to even learn about hormones it was just something that women had to deal with and I know I see a lot of patients in my practice that come in that are having all kinds of issues and they're just given a pill to sleep you know Aderall for Focus you know mood booster P but no one's really addressing ing the bottom line which is what is happening with their hormonal climate yeah and it's it's really a systemic issue I think you know everyone's relying on their training and education and unfortunately the current medical system was really built to fail the menopausal woman and we receive like you said in medical school maybe an hour lecture I mean I went through 30 years ago but and then in my OBG residency and even as a program director until 2018 we had no menopause clinics no Focus specific you know instruction on how to care for the menopausal woman we were kind of taught about menopause a little bit but like per menopause how to recognize it how different the Expressions could be all the organ systems that might be affected nothing yeah what's interesting and I've recently learned just from following you by the way your content is so good I mean thank you so much for delivering such valuable information but a lot of these symptoms that can actually start in your 30s some of these hormonal changes start way before I mean I used to think oh menopause that's like in your 50s you don't even worry about that but no it's kind of like this gradual process so tell us a little bit about you know some of the changes that happened starting in the third decade of life so why it starts so young and what is actually happening let's go down to the root cause I don't love that term it really does make sense here most people don't understand even physician that we are born females are born with all of their egg supply when we're embryos they start deteriorating when we're five months in utero by the time we're 30 we are down to 90% of our egg supply and by the time we're 40 we're down to about 3% on average when we run out of eggs either through the process of ovulation or just at treia what we call it you know deterioration with age that's it there goes all hor not all but the 99% of the hormone production from the ovaries for the rest of our lives which could be 30 to 40 years depending on how long you live so when we're in that 90% range you know to Absolute menopause which is the end of hormonal production from the ovaries you can start having symptoms from estrogen deprivation it's not like one day you wake up and the ovaries are debt it is a very dramatic tumultuous process of rise and decline like a roller coaster on its way down and so you could have symptoms as so average age of menopause is 51 normal menopause is still 45 to 55 so per menopause begins when you start seeing symptoms s to 10 years before that menopause so just do the math you know 45 minus 10 is 35 yeah so what are the symptoms that's a great point that you what what should people look for there are the symptoms that you and I were taught in medical school that we know how to recognize flashes night sweats osteoporosis vaginal dryness those are kind of the classical symptoms of menopause and really the ones that if it had what education I did have focused on those and the medication and treatments that were developed focused on relieving those symptoms what we know now in modern menopause medicine is that there are estrogen testosterone receptors in almost every organ system of our body and as those levels start declining we see big scary dramatic changes in brains bones kidneys lungs teeth Hair Skin General urinary system there is nothing that's left off the table so actually the symptom profile is huge so when we talk in terms of skin mouth eyes dry eyes dry skin dry you know we have decrease of mucus production decrease of oil production um thinning of the skin loss of collagen brain function begins to decline the brain fog is real and it's it's real yeah yeah EST it's inflammation in the brain due to the loss of estrogen we see massive deterioration in our bone density beginning you know in the first first five years of menopause we lose about 10% of our bone density and so it's really amazing how fast these changes happen not just related to age but to estrogen deprivation now do you start to see these changes and I don't know if there's been studies looking at for example CTS or whatnot looking at bone or looking at the you know other other organs starting as the estrog is there a is there like a threshold it hits and then you really start to see dramatic changes is it like right at 51 when you're completely out of it depends on what age you would begin your menopause so we have to do it in relation to when your natural menopause would be so some of the best work on the brain has been done by Lisa Moscone out of Cornell and she wrote um the double x brain and and just now published or coming out very soon I think in January is the menopause brain where she actually her research funds CT and pet scans of the brain of women pre Perry and postmenopause Andes and it is absolutely phenomenal the core of her research is Alzheimer's and Dementia and why women are affected at such a higher percentage than men and it's not because we live longer that has right the changes Associated well a little bit to do with it but really those changes are are you begin to see those changes starting out in the per menopause transition so really this should be addressed before you completely run out of don't wait until you're in your 50s to address these changes because by then some of those changes of art you've lost some of those functions and some of the organ vitalities now what can women do is there a blood test or what do you like if you have somebody that comes in you know maybe 30s or early 40s that is maybe experiencing some brain fog feeling tired you know just can't sleep or anxious like what what do you do in terms of blood work sure so um when we start addressing so as far as blood work I listen to the patient I discuss her symptoms I have kind of a checklist they're doing paperwork like most of us have before they even get to me and I have a menopausal scoring system that was developed by the australasian menopause Society off of the green scale this stuff's been around since the 70s but no one was utilizing it and so basically are you having brain fog are you having you know vaginal dryness it's list of about 30 symptoms that tells me right away She's suffering more than likely suffering from per menopause so when I'm doing blood work I'm ruling out hypothyroidism autoimmune disease very rarely am I having to do hormone levels maybe an FSH if she's had a hysterectomy and I can't use her period to help guide me but if you just listen to the patient and believe her and not attribute everything to it's all in her head or psychological symptoms aging I start therapy immediately now when I say therapy you know not everyone is going to be a candidate for hormone replacement therapy or want it when I talk about menopause care probably the same way you talk about skin care it's more than just one cream one potion one magic it is a toolbox so nutrition exercise stress reduction sleep stop smoking get moving you know all those things are just as important hormone replacement therapy non hormonal treatments for these symptoms um and possible supplementation if there's any deficits there I love that because all those factors are affecting your hormone levels right so maybe if you make some of those lifestyle changes or some of the diet changes you can actually boost your own natural estrogen so maybe you don't have to go on hormone replacement um you can do that for a while um but eventually your ovaries will fail no one gets out of this there menopause is not optional so you definitely how you kind of show up in perimenopause healthwise and your habits is kind of probably going to help Define some of your course and how bad your symptoms Syms are and how bad you're going to suffer so one of the latest studies one of the most exciting things is is showing that insulin resistance dramatically goes up with estrogen depletion and replacing that estrogen is helpful and so knowing ahead of time in your 30s that you're going to be at higher risk for insulin resistance and diabetes and getting ahead of that with nutrition and exercise habits you know is can really change the course of your health and life for long term so now let's say you're in your 40s you know not quite 50 1 and the symptoms are getting you know even more pronounced maybe at this point you're having hot flashes or whatnot tell us about sort of our this new wave of bioidentical hormones because I know the original study that was done looked at like con perin like synthetic hormones but now it's the bioidentical hormones that are becoming major players and how that's different and how that's kind of changed so estrogen first came out on the market in the 40s I think and um a lot of it was synthetic um in the 70s there was a book uh feminine forever and it really it was kind of icky but it was like get your wife back kind of movement you know keep her sexy forever but it really got a lot of women on estrogen only hormone therapy we realized quickly that when you don't give a woman progesterone with estrogen and she has a uterus you put her at risk for in demetrial hyperplasia and cancer so then we had to add a progestin so the next wave was perim was ever able to be developed which comes from the urine of pregnant horses Prim Marin pregnant mared and um It's a combination of 10 different estrogens they are natural but I'm not super happy ethically with how they get the urine of the horse and you can go look into that so I really don't um the progestin combined with that is medroxy progesterone acetate or proa which is synthetic so not to like beat up on synthetic versus natural everything has to go to the lab for processing we're not rubbing yams on oursel and making estrogen right but if you look at the Modern prescribing practices and the newer studies coming out and looking at observational studies things that are bioidentical just means it's chemically identical to what your body naturally made so that would be 17 beta hydroxy estral that is what your ovaries make okay there's also estriol which is what our placentas make in pregnancy if you're ever pregnant and there's estron which is usually made in the periphery and fat cells from the conversion of testosterone very long explanation so those are kind of your top three bioidenticals I choose when I'm doing menopausal hormone therapy to give the patients back what their overs used to make which is estradiol I see fortunately I'm able to find that in regulated versions multiple strains oral non-oral and we can get into why those are pretty different um later and for progesterone I give them progesterone not prestant so the big umbrella is progestagen which is synthetic and natural and so I do tend to stick to Natural yeah and and so let's talk about you know with estrogen I mean now when I see women in their 30s or 40s experiencing hair loss and dry skin I automatically say see your GYN because you could be having some of these hormonal changes so is that is I mean is that something that's reasonable to to to give how do you decide who gets can absolutely begin treating a patient um in their per menopause we don't have to wait till full menopause you don't have to go A Year Without a period before you're a candidate for menopausal hormone therapy and that may the hormone therapy and per menopause may look like different things the biggest difference between what you would think of as a birth control pill and what you think of as menopause hormone therapy is dose birth control pills were developed to suppress ovulation so you don't get pregnant okay we use them to treat a million other things cramps acne you probably use it in your practice you know for acne for young patients then there's high dose medium dose low dose right under low dose is high dose menopause hormone therapy I see so it's very little amounts of a Continuum and so it's about a quarter if you look at average it's about half to a quarter of the dose of what you would need to suppress ovulation versus what you would need to stop a hot flash which is why these two things were developed and so if my patient imper menopause is suffering and she's having irregular periods heavy periods acne Crim something I feel like higher do I need to suppress her ovulation so that we can get this combined benefit I'm going to go with those higher doses versus she's kind of in late Perry menopause she's really having hot flashes night sweats you know I'm just giving her a patch in the progesterone you know in the lower doses that we could continue long term now what about like effects on the hair is the birth control for example or the skin because we know that estrogen is so important for collagen production you know hair restoration and and so protective of hair does does birth control pills is that more estrogen so is that better do you do you see more benefits or not not necessarily so many different for hair you know specifically when we're talking about hair or skin you know we're talking about high Androgen states which could lead to male pattern baldness where you're losing the temporal area well you can talk more about this and acne so that's kind of one area versus female pattern hair loss which is different you know where you see the widening of heart in general um and kind of a diffused hair loss and so um you know I always tell patients or you know people who follow me you know if you do some simple things and it's not working go see a dermatologist there's million reasons why you could be losing hair nutrition deficiencies mail pattern female pattern you know Etc and we want to make sure we're not missing on autoimmune disease or fungus so you know go to the expert to figure this out um and you know R gain's not going to work for everyone all these over-the-counter things the the vitamins you know they're great but there it may not be what you need so let's go figure out what's going on before we especially if it's severe before we invest any more money in these cures to see what happens and so for hormone therapy it depends if it's Androgen driven yes then you know birth control pills menopause hormone therapy might be helpful um if it's female pattern hair loss it's kind of unknown I just wrote the chapter on that in the book and it's like it might respond it might not we really don't know it's probably better to do red light therapy or or something to increase blood flow to the scalp you know to try to get the the hair follicle healthier you know at that time but it's it's such a pain point for patients yes it's really complicated because then you know that whole estrogen progesterone that could also affect your Androgen dominance right differently so some progestins that are found in different birth control pills might be better for acne or that's right for hair loss yeah than others so it's I tell my patients a lot of this is trial and error we do not know how your body's going to react so we just kind of have to make a educated you know guess almost and then go from there so what about PCOS I mean is that is that part of the whole per menopause r or is that a completely different probably 80% of PCOS like looks just like per menopause it literally is very very similar in what your Cycles are doing how your body's reacting to what's going on um so I have actually have a Blog about this with a spreadsheet where I PCOS per menopause and checkboxes so you could be you know really hard for a woman who's dealt with PCOS her whole life to ever and I know this because I am a you know thin prototype PCOS patient I you know whole life and so I really gaset myself for a while in Perry menopause because I you know my brother assumed it's psos I was like you're never going to be regular what's going on you're not sleeping because you're depressed you know all this stuff and I was like wait a minute I'm I'm in the puzzle because I I think that a lot of people do fall into that trap thinking that it is PCOS but it ends up not being you know and being Perry manopo I didn't actually realize the symptoms overlapped so much so much probably 80% of the symptoms will overlap so tell us a little bit about PCOS I mean you expect to have fertility issues cuz I just see acne right hair loss and increased facial hair but what are some of the symptoms women should so um it you know it can start as early as adolescent so mine kind of began I was in medical school when we figured it out and I was th I was very thin and so I was very very irregular um like I was skipping three four five months periods at a time I had signs of high androgens with the um acne hair growth everything I'm cun I have dark hair I you know I just thought that was my you know um I was a cheerleader in high school and I would have to go get waxed because my I couldn't wear the short skirts because growing was halfway down my legs you know and so they didn't have electron I couldn't afford all that back then I just remember like laying on that table with this woman ripping rut wax I get INR you know so that was my presentation and then of course um once I decided to start a family I had major fertility issues so both of my children I've lost two M I've had two miscarriage four pregnancies with art lost two and then I have two healthy kids so very very fortunate that I was able to kind of surpass you know get through that and then thought about trying one more time and then realized I just wanted the option we didn't want another baby that's a lot to go through and and I think it's it's really challenging when you don't know where to start what what is the treatment for PCOS what are what are your top three treatments so it's it's kind of a misnomer and we calling it polycystic ovarian syndrome which is just a symptom and not everyone with P you know with the Endocrinology of PCOS actually has polycystic ovaries really what's happening is insulin resistance you are born with a form of insulin resistance where your insulin levels are running so high it's affecting the ovary's ability to ovulate regularly and it's much uh if you're heavier it's more related to your body mass and your fat Mass associated with insulin resistance and someone who's thinner it's more of an inflammatory and maybe a broken receptor we think and so um so the treatment like for me if you were heavy a lot of people can cure their PCOS with you know nutrition and exercise and so and fat loss in the right places and you know but that's really hard to do um unless you're on OIC you know well now with OIC like what I'm waiting for is all of the unplanned pregnancies with the women on OIC who were infertile and now they're going to be fertile because just from losing weight when the big wave of gastric bypass came through we were seeing pregnancy after another that right huh land you know and so and they hadn't reached their year of stability and so it was really really you know it was hard as an obstetrician to keep her healthy and and get all her nutrients in while she's still healing from this surgery um when when her gastric bypass surgeon forgot to tell her you need birth control this first year until you stabilize so so we're waiting I'm not doing of cetric anymore I've passed that baton but I'm waiting to hear about all the OIC pregnancies coming out I'm sure it's coming so weight loss and then what other so weight loss and then you know like me in the thin case so what if you lose all the weight or you can't lose any more weight you know what do you do do you walk around with a testosterone level of 90 and all these symptoms and run the risk of endometrial hyperplasia no so I chose birth control pills which was a wonderful option for me I was in medical school I did not want to be pregnant I wanted to get my Cycles regular you know I was having acne it literally cleared all of my symptoms up in the background I was still insulin resistant so I watched my diet did all the things you know avoided the sugars and exercise but you know it really was helpful for me and for so many patients they do really really well on a birth control pill just to suppress the whole system and then when they're ready to start a family we don't waste much time we know immediately they might have trouble um but a lot of PCOS patients will kind of have this little window of fertility right when they get off the pill so they take advant within the first like three months like getting off huh yeah how interesting W well that's yeah that's really interesting so my other question is so there's a lot of controversy right because we know all the protective benefits of estrogen for almost every organ system but what are the drawbacks like you know then I hear people well if you take estrogen you're going to get canc you're going to get breast cancer you're going to get sure yeah so tumors you're GNA have a heart attack like what are so the Whi really screwed women in America like in the world the Women's Health Initiative really metant well it was a study that they knew from observational data that women who were on menopause hormone therapy beginning in their 50s had a lower incidence of of um heart disease and so the study was designed to say well is that just because they're healthier and they're better off socioeconomically they go to the doct after they get Tre you know they're more likely to be healthy and have less heart disease or is this really due to the hormone therapy so the only way to prove these things is with a randomized control placeo controlled study so they was the first one like this of its kind and they used primin if you had a hysterctomy you got primin if you didn't Prim Pro versus placebo in both arms we had four arms going and groups of women and so found when they started the average age was 63 okay they trying to prove that's way later than women start trying to prove heart disease right the end the goal was that she have heart disease they were also tracking breast cancer so the Primo arms stopped after three years maybe because they did see a nonstatistically significant increase they went from four out of a thousand women per year to five out of a thousand per women per year of breast cancer so that arm stopped immediately the headlines went out estrogen causes breast cancer da 80% of hormone therapy prescription stopped immediately the calls were going crazy in the doctor's offices like oh my God you're trying to kill me and it was the number one Health news story in 2002 wom was the Women's Health Initiative what they found was no change in heart disease none starting at 63 and then they found the estrogen only arm continued for two or three more years they found they had a decreased risk of breast cancer versus oh really yeah it was protective so what it actually was was not the estrogen it was probably probably the Prova that was increasing the risk of breast cancer the progesterone the progesterone so just like estrogen inre uterine reanalyzed walk back there's been multiple multiple multiple studies done the American Heart Association has come out in favor of hormone therapy but there's some caveats so it's very nuanced when you talk to a patient estrogen is better at protection than cure okay so estrogen is a powerful antioxidant and anti-inflammatory hormone and it's everywhere in our body it's protecting our brains our vascular system our coronary arteries our lungs our kidneys you skin all of it when we take it away the best thing I could ever do is give you back your 25y old ovaries I can't do that those are gone the next best thing is hormone replacement therapy okay probably in the form of estradiol and progesterone okay if we start young we don't see and you in up to five years there's no increased risk of breast cancer on estrogen and progesterone okay so it was the women who were older so they felt like they probably had pre-existing disease or were on their way and estrogen just kind of fed the cancer and made it popped up so women who were actually diagnosed with breast cancer on hormones versus placebo were diagnosed at a lower stage and live longer and had a better survival rate so potentially it could be helpful it is helpful so we know that starting within five to 10 five years of your menopause you will have decreased dementia and Alzheimer's starting within 10 years of your menopause you will have decreased death from cardiovascular disease hormone therapy is more effective at prevention of coronary artery disease than a Statin for women wow wow and they feel so much better God I mean we're just giving you back the water you were drinking but there is a window of opportunity for these long-term Health protective benefits you must start young once those disease processes have started started estrogen is not helpful and it might even hurt it's prevention rather than cure so you're talking start in your 40s I I would say before in per menopause you should start we know if you start in per menopause you're going to have decreased depression we know you're going to have decreased collagen loss of your skin you know um one caveat about systemic therapy for skin is that topical estrogen is better for elastin um topical estrogen like as in a cream or as well cream or whatever form you want to get patch or something um topical meaning you're rubbing it on your face local I see I see lotion okay yeah yeah so I've been using like a 3% estriol cream the studies are old on it but they're there and it did show Improvement of elastin and collagen where systemic only did the collagen yeah that's that's awesome and then so tell me um like progesterone for example I have a lot of patients that have gone off off their anxiety medication their sleeping medication and they swear it's the best sleep they've ever had you know taking Progesterone and and so tell us a little bit about progesterone in terms progesterone is mandatory if you have a uterus and you're going on estrogen it's optional if you don't have a uterus or you have a IUD a marina IUD and the oral micronized the prometrium oral micronized progesterone has wonderful sleep benefits like me if you're not even on estrogen just progesterone alone at night you have much better sleep scores than you do off of it so for my patients you know I always tell them take it at night before you go to bed you know keep track of your sleep you might you probably see a big difference here we can go up on the dose if you feel like you need more it's trial and error again here it's also seems to be really powerful for anxiety there's something kind of relaxing about it so especially if you're laying awake at night with racing thoughts and that you know you're waking up that 3:00 a.m. wake up 2 am wake up and your brain is going progesterone seems to be really protective against that now do you worry about it causing any issues with breast cancer because you'd mentioned no in France they did a study observational study looking at about 880,000 women and they stratified breast cancer risk by the type of progestin that they were taking the synthetics versus and and the progesterone and oral progesterone Micron progesterone did not have any association with breast cancer so I feel very confident that I'm not going to increase your risk by giving you these medications starting young continuing you know as long as the risk outweigh the benefits for you now there's some caveats if you have a family history or you have a genetic disposition I'm not saying no you're not a candidate but that's a deeper discussion with your doctor I love that and you can just take it for as long as you want right as long as for you away the risks you can stay on it forever and um age at which you have to stop anymore okay wonderful and then so getting back to you said the oral form versus the patch and then what are these pellets I hear about okay about these pellets you know there's all these hormone clinics now popping up all these ER doctors and yeah radiologist um you know listen women were desperate women were women are desperate and there's different ways to put medicine in your body right we have so when we talk about estrogen therapy we're talking about systemic versus local systemic therapy is higher dosing meant to treat your entire body local dosing is just putting the estrogen where you need it and it doesn't really get absorbed systemically that would be on the face in a cream or V usually vaginal vaginal estrogen and some patients need both systemic and vaginal to get treatment so when we're talking about systemic therapy we have oral like pill or we have non-oral okay so anything we ingest orally right goes through our gut gets picked up by the hepatic vein into the portal CC circulation and gets processed by the liver when that bump of daily estrogen hits that liver we see an uptick in inflammation and clotting factors it's slight but it's there so seven out of 10,000 women will have a blood Cloud on oral estrogen that would not have otherwise we can negate that risk it's very small with a non-oral formulation fortunately we have patches in multiple strengths and they work for most people they're FDA approved so insurance is going to cover it I'm looking for the most economical safest option for my patient so would be estrogen you know why I Avo avoid the oral formulations if I can't um for that now there are other methods to deliver estrogen to your body there are creams usually compounded there's an FDA approved gel works great there sprays Mists the UK they usually do transdermal like creams and stuff um but in the US uh we have mostly patches and then the estrogel but there's no generic for that the patches are generic um now biote is is a company that started out making testosterone P pellets have been around forever okay but just somebody got real good at Savvy about marketing and so biot was developed initially for men to give them testosterone they created this testosterone deficiency syndrome thing and you know everybody needs testosterone whatever I don't treat men so I don't know anything about that then they're like why can't we give this to women well okay um our our testosterone levels do slightly decline with age and they do go down a little bit more with menopause and women do benefit from testosterone supplementation especially in hypoactive sexual desire disorder so this really smart brilliant marketing company billion dooll company is like H we should Market these to women that's smart marketing right so they start marketing to the med Spas to the ob Jens and basically the doctors buy the pellets wholesale from the supplier ship their office and so then you have to buy the pellets back from the doctor and then pay for the insertion so they're putting as they're putting biest and triest in these pellets claiming it's safer more natural I have no reason to give woman a pregnancy hormone if I don't have to you know weak estrogen it doesn't work as well as estradiol that's just marketing to me so you can't use you can't do estra diol in these pellets they don't make them with just EST just doing biest and triest so okay uh that's their choice but there's no and there's no data there's no studies they do no studies here's this billion dollar company that is not doing randomized control clinical trials to prove that their product is superior to others so look I'm not going to make a woman feel bad because she found the only person in the world who would offer her hormone therapy and it was in the form of a pellet what I'm telling her now is you don't have to pay that much it's not better safer stronger if you love it and you don't mind paying that amount go for it one of the caveat about testosterone pellets they are in their formulation packaging which I have seen are recommending to Super physiologic dose of woman routinely between 150 and 250 for deiler okay a female normal healthy range is about 20 to 70 so they're getting a lot 25 and so they are routinely tripling quadrupling what a woman would have and they're like oh no they and oh here's our evidence we've done it to a million women and they feel great I'm like so you're not a yeah so you you're not a fan of where is the I know they're having acne I know they're losing hair I I do see them I see them with hair loss and acne there is a steady state of How High your testosterone levels are as a woman with increasing visceral fat and it doesn't happen to men I mean they their bodies are great you know they certainly have more energy and and but they're having all these other physical attrib have to go that highing them to little men what they're doing and so I'm like but you know you have better options I think than to be routinely overdosed and charged of 5x premium you can get good quality safe efficacious hormone replacement therapy without and yeah it's more convenient it's once every three months fine but I'm seeing patients in my clinic I'm checking their testosterone levels coming off the pellets three four five six months out and they're still running three and 400 yeah that's really high wow massive overdosing going yeah so stick with estradiol or progest and and progesterone because you need that to make sure you don't get you know uterine cancer and all that well I really want to talk about the Galviston diet so tell us about that because I'm a huge fan of nutrition you know when it comes to skin and certainly hormones tell us what that's founded you know what is that based on and what is what is it what is the Galviston diet let's go back to like 2015 and so I was in late Perry menopause my brother had just died I was working my tail off as a residency director and so how old how old were you I just want to I was um 47 okay I'm 55 now so math yeah 47 and um and I had gotten off the pill to kind of see where I was hormonally right at the time when my brother got sick and I went home to do his end of life care and he died very quickly he had inst stage hepatitis and liver failure from HIV and hepatitis and I went through really bad grief and depression and all that and I just kind of like didn't get it I wasn't t with my body I was in this fog and you know I had brain fog and I was like you're just depressed you're gaining weight CU you're depressed you're not eating you know I wasn't working out I wasn't doing all my usual habits so then the fog lifts and the degreef lifts and I'm like okay you're chubby what's going on like you you've always kind of been thin and and let's let's get this going and then I realized I was menopausal and all of my usual like tricks to get back to my little skinny self were not working okay and I got incredibly frustrated and I realized I sounded like my patient you know who are the same age where Mary CLA I don't know what's going on I'm not doing anything different I'm eating right I'm exercising and I would Pat them on the knee and say work out more eat less come on girl you know you're just you know you park further from the grocery store while you walk I mean the same ridiculous stuff was coming out of my mouth because that's what I was taught to say until it happened to me and I realized I am literally starving myself I am literally working out twice a day and yes I'm losing a couple pounds and it would just bounce right back on like I could not find homeostasis now I was not being healthy I was not eating Health you know I just was like calories in calories out it's got to work I was doing these crazy cleanses I mean like anything so finally my husband was like honey the kids are watching I have two teenage daughters at this time you know they've already watched me go through like the biggest loss of my life my brother and not do well I was just a zombie walking around the house and now I'm like obsessively calorie counting and skipping meals and working out all the time and he's like they're watching you this isn't right you're smart you're smart figure this out you know so so I called The Nutrition department at the University I was employed at and I was like what is going on in menopause why are why is everyone G weight and they're like well there's something going on with inflammation it's probably something to do with hormones here's a bunch of Articles so they send me down all these rabbit Trails of looking at inflammation and looking at nutrition and I realized I don't know anything about nutrition not really like it's like pornography you know it when you see it good nutrition we don't get any training on so I decided to enroll in The Culinary medicine program at tan and I went online and I had to fly to New Orleans for some labs and stuff but I just learned so much about nutrition and food allergies and like you know how it all works together and then at the same time I'm doing deeper and deeper Dives in menopause education and realizing the CME that was put in front of me by the American Board of OB gen re when I say rarely like we have 120 articles we're supposed to read every year to get recertified for our boards maybe one on menopause out of you know I'm like wait wait wait 40% of the female population is in menopause exactly it's you know like why don't we get 30% of the research and the Articles and the you know there's all this obscure stuff it's like to get someone half percent healthier you know this like massive and instead of like this is where's the basic menopause care like where is all the walking back of the wh and and hormone therapy and osteoporosis and what we know now about brain fog and brain health and it's not there and I'm like whoa you know so then I learned about the North American menopause society and menopause.org and I got involved there I'm certified from there so you know I just really was like I got to step outside of what's expected of me if I'm going here and this is where I want to go this is where I'm being called care so I make this plan for myself and my patients on all this great stuff I learned in nutrition I love the stuff I learned about intermittent fasting again it's not for everyone but it can be a really powerful tool for inflammation not great for weight loss I learned about the quality of nutrition anti-inflammatory nutrition the Mediterranean diet like the Blue Zone like why all that works and why habits are more important than one nutrient and so and then I looked at what I call fuel refocusing like really doing a deep dive on micronutrient of what most menopausal women are missing in their diets or not able to absorb and so I put it all together into this plan that I make copies of down the road and I was handing it out to my patients and they were all doing it and loving it and then I shared on social media and that's when you know things kind of exploded for me I didn't I was just playing it was just a passion project that I was sharing with the world and then some Savvy business friends were like um you should make this a book or a program or something and that's kind the galson diet was boring and I I love that I began talking more and more about nutrition and menopause on social media the floodgates open for people just that I was even saying the word menopause and like story after story after Story of gaslighting and misunderstanding and and not being able to find help or or paying out just tremendous amounts of money for basic hormone care and you know and so then I just saw the conversation getting bigger and bigger which is where we are now I would say you're probably one of the leaders in raising awareness for menopause and love that it stemmed from your own experience you know and and helping your patient made really incredible friends yeah social media who are also in this space and I'm learning as much from them as they are from me and we're constantly and sharing articles and information and like they keep me on my toes and beauti I I have my menopause sisters now that's awesome I love that that's amazing and I'm so happy that women are finally being heard because I do feel that a lot of times they're sort of known as the whiny you know patient that comes in complaining of hair loss and fibromyalgia and all these other things something really terrible this is horrible um but this happened and when I was in residency you know we had our gy clinic gyy clinic you'd have a woman coming in 30s 40s with multiple V complaints right just like you said hair loss fatigue lethargy your periods are getting irregular you know whatever and it was I'm not going to tell you the gender of who would they walk down with their cowboy boots and be like hey I went to residency in Texas hey you got a ww in room room four good luck with that ww ww our ww as a whiny white woman or white that's terrible it was horrible it was horrible and you know me I don't want to get fire and I'm like okay you know okay my she's got you got five minutes get out of there you can't help her Nothing's Gonna help her she's that's so sad you can't help her well now you can have estra estral patch and some progesterone all your symptoms are going to go away so the is back to like nutrition if somebody can't take hormones for whatever reason what are some top three foods or methods in terms of the the diet that that can help yeah one make sure you're getting enough fiber in your diet and you'll probably have to track it because you don't know how to do it yet you know women are only getting half the amount of recommented fiber in their diets per day and I'm not talking supplements the majority of your fiber should come from food now I I do I sell supplement I have my own fiber supplement I'm drinking it right now but like you should be getting 25 grams from food in your diet per day it does what are some high in fiber sure so legumes so beans you know nuts seeds um fruits vegetables berries are super high avocado I'm an avoc day girl pretty much you know um I can get 10 12 grams a fiber a day from eating my avocado a day plus healthy fats plus vitamins plus minerals plus magnesium you know so so when you're getting high fiber foods you're also getting this incredible Encyclopedia of other minerals and nutrients that are keeping you healthy and function in you know at topnotch while your body's going through this estrogen withdrawal fiber Number Two Sugars added and cooking processing and alcohol and if you limit those added sugars to less than 25 grams a day you are going to have less insulin resistance you are going to have less visceral fat and you are going to have less inflammation and that goes for artificial sweeteners too artificial sweeteners are a whole another category so yeah I mean like in our in gison diet we talk about sugar substit so like anything that's like chemically based Rel light you probably should leave that aside you know that should be rare if ever you know the Splenda the stevia it's not my favorite and you know we use a little bit of it to sweeten the fiber so it's palatable you know like that should be just a little bit here and there but you need to train your body not to Crave those sugars it is an addiction like it you know your body craves it you can break it so you know the problem is you never if you go if you go hard for the art for the artificial sweeteners or the plant sweeteners you're never going to teach your body to like enjoy food without it being sweet so that's number two and then three three is I would say vitamin D you know um it's 80% of my patients are absolutely deficient in vitamin D I'm not talking borderline I'm talking M too it causes a lot of hair loss in my clinic drag so I'm like the first thing we need to do is get your vitamin D back to where it needs to be and often probably 60% of the time they need a prescription stength which is week just to get them up and then maybe we can do 5,000 a day for maintenance but I mean just lifting them out of that vitamin D deficiency can do so much for a woman and you can count on being vitamin D deficient in menopause well your body isn't as good your skin isn't as good as making vitamin D as you get older and we're not outside as as much as we were when we were younger either I was great about my face but I mean my neck is 20 years older than my face it's so true we're so good with our faces but the neck and chest skin is so much thinner and we just don't think about it as much so it gets damaged a lot faster so I wanted to ask a few questions that we got from the audience what about these menopause testing kits that I see people selling at CVS I have an interview with Laura Magazine about this exact thing it's a maybe here's what I like about the clear blue are these menopause test kits they're using an FSH level and at an FSH of 25 or above you are like very likely if you have one several days in a row in late per menopause and so the the clear blue easy kit comes with five tests and you do it over like two weeks or something and it's really elegantly done and they have great data to support it now do I think every woman needs to run out and do one no um but it can if you have one test that's above 25 and the rest are normal then you might be an early perimenopause so it gives you some clue but the most powerful thing is their app they do a symptom score collect your symptoms they print out a form you can take to your doctor with the evidence and the Articles to say here and I feel like that puts more power in the patient hands so they're not paying me to say this but I'm like you know it starts a conversation and so I think it's worth 25 bucks you know to have some evidence in your hands with the medical research Journal article showing a print out to a healthcare provider who you might be educating because like we said we didn't learn about this stuff that's right yeah so it gives it gives women a voice you know some some evidence to gather before they go in to see their doctor I love that okay well we're going to let you go because I know you have a hard stop but I want to play a game called slay or nay okay and um and these are just gonna be kind of Rapid Fire uh number one one size fits all healthc care Oh nay no being a social media influencer slay female Viagra no such thing no such thing I mean there is but it's not for what you think youal does estral enhance your sex drive because I have patients that come in I'm having orgasms again because I'm on on the PCH topical estrogen can inrease blood flow to the area and improve the sensitivity of the clitoris and so that's a that's a sleigh but as far as what it does to your brain and desire it doesn't help there I see key gos absolutely slle essential oils for menopause treatment nay no yeah I'm not I like the way settling for having a low libido nay nay okay I love it thank you so much for joining us it was so nice to connect with you so tell our audience where can they find you I know you're a huge Tik Tok star and you're very active on social media so what's your handle so people can Dr Mary Claire on on um Tik Tok and Instagram I love it and then we'll also link your Galviston diet so people can learn more and your website and your handles thank you so much for joining us so welcome Take Care thank [Music] you