50, Now What?!

Alicia Sutton: Hello everyone and welcome to 50. Now what today's episode is not only exciting, but essential as we discuss the topic that affects nearly every woman navigating this decade of life menopause from night sweats to hot flashes, to hormones, and dryness. No topic is off limits today. And here to answer some of your burning pun intended questions is Dr.

Alicia Sutton: Mary Claire Haver, a board certified OB, B G Y N, physician and menopause specialist, who is committing her career to helping women understand our bodies and options as we grow through the changes associated with menopause. We're so grateful to have her here. Let's jump into it. Dr. Hare, thank you so much for being with us today, and I've been reading your book, the Galveston Diet, and it's designed specifically for the unique process women go through when we reach midlife, and I love it.

Alicia Sutton: Oh, thank you. Absolutely love it. And I just have to say, you know, there has not been much, at least that I recall, I mean, I'm 52 now and I've been in menopause a minute, and I hadn't had anything that essentially. Normalizes what's normal about the physical changes in women's bodies as we age, as your book does.

Alicia Sutton: And I think the big difference, what's a huge difference is the fact that, one, you're a woman. Two, you're a medical doctor at obgyn and third certified in, uh, culinary medicine. So I just wanna take that, I wanna give you that moment and just say thank you.

Dr. Haver: You're welcome. You're welcome. I'm really, um, the biggest surprise for the feedback of the book was so many people who have read it have come back and said, you made me feel heard.

Dr. Haver: You made me feel seen. Yes. Just the stories of my own journey through menopause and the stories I shared in the book of other women's journeys, how it relates to health and nutrition and weight gain, or, or other symptoms. It really took social media, you know, because in the patient's office, I'm just behind a closed door and it's one-on-one, but.

Dr. Haver: Really when I began this conversation online was when I, I started to realize there was this vast black hole of information Yep. Available to women about all things menopause and just touching on subjects in the, in the wellness book, women, just the out, just by and large, just saying thank you for just.

Dr. Haver: You know, I'll, I'll try the diet, but I'm just so happy somebody out there is realizing what I'm going through. And,

Alicia Sutton: and you know what, and I, I think that happens with all women, cuz for me, like with all young girls growing up, you, you get your period and suddenly your clock is ticking and that's all you get.

Alicia Sutton: And then somewhere around somebody will say something about a hot flash and that's pretty much. That's it. And so that's why it's so important for to have you on the show today. And I want to talk about some of the things you talk about in the book in terms of the process or the stages of menopause and some of those symptoms that sometimes you don't even know that you're having them and the potential health risks with some of those symptoms as well.

Alicia Sutton: And we'll just start with that. I mean, you. You lay it out perfectly from perimenopause, I'll, I'll let you speak.

Dr. Haver: One of the things that surprised me in this journey, and as I learned more and more, was when I finished my training program, which was one of the best in the country for obstetrics and gynecology.

Dr. Haver: I would've told you that I knew everything there was to know about menopause. That I needed to know and that I was a great menopause provider and life has taught me otherwise. Mm-hmm. Even as a former program director. So my, one of my jobs in my, you know, once I've graduated, was to teach other ob gyn residents how to be good OBGYN providers.

Dr. Haver: We do not, and to this day, prioritize. Women's health outside of reproduction. Wow. As a medical specialty, this is a systemic problem. This is an educational problem. This is a mindset problem. This is a societal problem. It is. It seems to be that our value as. Agenda is in our ability to bear children.

Dr. Haver: Mm-hmm. And that almost all of the mind research dollars, you know, medication, therapy research goes into keeping us healthy so that we can have babies, have babies now. That is important. It is so important being a mother is. Is pretty much very, you know, is a huge part of who I am, but where we're not, where we're failing patients, I think is that once we're done with reproduction, a huge amount of women, unless they have no symptoms, which is rare, are feeling left behind.

Dr. Haver: Yeah. And what we're learning medically is that we are leaving them behind because they are not as healthy as they could be with our guidance. Wow. But you don't know what you don't know. And. You know, it took me realizing something's wrong, something's wrong with me. What I was taught is not adequate. I need more information, more training, more so that I can take care of myself.

Dr. Haver: And then I turned it around on my patients and then started talking about it on social media, which is where the conversation exploded.

Alicia Sutton: Right. And that's the thing, every woman, regardless of where you are in your age, you, you have your menopause story. And it's so funny you mentioned about, you know, having children, not all women will have children, not all women.

Alicia Sutton: You know, that's not necessarily part of their, their, their life, right. Uh, journey. Right. But every woman, every woman is going to go through menopause. Right.

Dr. Haver: More women will go through menopause than bear

Alicia Sutton: children. Absolutely. And I'm loving that this conversation is here and I have friends and like I'm sure you do too.

Alicia Sutton: And, and people in your, in your field, everyone's dealing with. Weight gain. They go like, what? How is this happening to me? And we have our menopause story. I was thrusted into menopause after, you know, I was diagnosed with the BRC one gene and then, you know, decided that it was in my best interest to have the ectomy.

Alicia Sutton: But then overnight, you know, I'm boom, I'm, I'm thrown into the fire, hot flashes and all, no pun intended. And with no real substantive guidance or alternatives. To pills or medication. It was always just, here you go, put this patch on. And it was just kind of just pumping me up and those things weren't helping me either.

Alicia Sutton: Whereas you're giving some substantive guidance about how to deal with this phase in your life. Right. I guess my question to you is, is it all about, at least according to your research about hormonal balance,

Dr. Haver: So I hesitate to use the word balance. Um, okay. Only because it's kind of become a term that's been used in marketing and not so much medical.

Dr. Haver: Got it. You know, when, when before our menopause, when we have, for those of us who enjoy normal menstrual cycles, our hormones look like an EKG every month. Mm-hmm. Up, down, up, down, and then straight up, down, up, down, straight. And then as we go through either surgical menopause or natural menopause or chemically induced menopause, however you got there on your journey, that estrogen production goes either through this transient state or for you, you were surgically induced.

Dr. Haver: Yeah. Menopause overnight. And so when we look at how do you one, get rid of the symptoms that may be so disruptive to your life, but not only that, what we're realizing now in today's menopause conversation is this lack of estrogen, however you got there. And for you, it's more risky. Yeah. Is that this lack of estrogen is also leading to some serious long-term health consequences, such as increased risk of cardiovascular disease, increased risk of stroke, increased risk of dementia.

Dr. Haver: There's a time continuum, the earlier you go through, the higher those risks of chronic disease are. Wow. And what can we do to attenuate that? You made the difficult but important choice to have your ovaries removed to decrease your risk of breast cancer. So now what do you do? Okay, so when I approach menopause care with a patient, I've chosen to focus my practice now only taking care of women in wherever they are in their menopause journey.

Dr. Haver: I don't do surgery, I don't deliver babies. I just. Talk to women all day. Right. And I approach it as a toolkit. And when you open your toolbox, it kind of looks like those caboodles some of us had when we were younger. You know, you put on your makeup. Yeah. And so the biggest, most important box is going to be, I think, nutrition.

Dr. Haver: And so making sure, because that not only affects how our body reacts to the lack of estrogen, it will not put estrogen there that's gone, but it will optimize our performance without the estrogen, right? So you've gotta make sure your nutrition is maximized. And we have lots of great studies that show different eating patterns will lead to less hot flashes, less night sweats, less disrupted sleep, and.

Dr. Haver: That will therefore lead to less health risk. The more you hot flash, if you're a super flasher, your risk of all these diseases is higher. Wow. Mm-hmm. And that now we're really diving into looking at variations within different backgrounds. So women who have African backgrounds, they go through earlier, couple years earlier than Caucasian women, and their symptoms are more severe, therefore leading to higher risk.

Dr. Haver: They're also less likely to be offered hormone replacement therapy. Wow. And less likely to actually go to a gynecologist to talk about it. Right. And so, you know, now we're seeing what's happening overall as a gender. Okay. So we're getting that down. Now we can kind of divide it up into other risk factors based on, you know, Different racial backgrounds and racial disparities.

Dr. Haver: Oh, that's amazing. So we're, we're getting there. You know, people are looking at it, they're talking about it, it's getting put on the, on the burner. So, so back to the toolkit. So nutrition is front and center, then it's gonna be movement. Okay. Okay. And I hate to call it exercise because Right. We all have to have a non-negotiable commitment to moving our bodies.

Dr. Haver: And we do cardiovascular exercise to keep our hearts strong, decrease those risks, right? And we do strength training or resistance training, however you want to. Whatever that looks like for you, that brings you joy right in to keep our bones and muscles strong. All of those three work together to keep mm-hmm our brains humming and to keep our hunger in check.

Dr. Haver: And, you know, all of this works together. Okay. Right. The third box is gonna be pharmacology in my office. And so we begin a conversation around hormone therapy, if you're interested, if you're a candidate, if you have any contraindications. And then if you, if you're, absolutely, it's, it's the gold standard for menopause care is gonna be hormone therapy, but, But in your case, that may not be an option for you.

Dr. Haver: You opted to have those hormones taken away to, to potentially decrease your risk of breast cancer. So say you're not that one. Well, now we start launching into what are you suffering from and what can pharmacology we know? So for example, for hot flashes, we can use things like clonidine. We can use things like Neurontin and there are some non-hormonal supplementation that might be helpful.

Dr. Haver: Not great, but it, it may be helpful for some. Right. Trove and ashwaganda and you know, other things that you may be willing to try. We also talk about stress reduction, the sandwich generation that our ages are in. Yes. We're worrying about parents. We're still taking care of adult children. You know, we seem to not be able to get a break here and, and talking about putting up boundaries and stress reduction and also sleep optimization.

Dr. Haver: Trying to make sure that we are getting the best sleep that we can. It's

Alicia Sutton: amazing to me that, you know, we're talking about people, not, we're just not getting sleep. And I, I'm one of those people that, you know, I was, and for years, I think there's almost this cloud around it. For years, I was proud that I could stay up all night.

Alicia Sutton: I was this night aisle, I was always just grinding through and I was just ripping. My body apart and it was elevating that stress. It was making it harder to to move because I was exhausted and then I'm wound up on coffee. And then it starts to just roll into all these other patterns that feed into these higher risks.

Alicia Sutton: And one of the things too, I think for most women who gradually go through the process, they go through the perimenopausal menopause and then. Fall into the post-menopause is that it's almost like the wiring got tripped. Like suddenly everything is askewed here. I'm like, okay, what is going on here? I'm hungrier, I'm tired, I'm

Dr. Haver: irritable.

Dr. Haver: And the symptom profile is different for each of us. No one of us, even identical twins Yeah. Are going to have the exact same reaction to their menopause. And that's what makes it hard to diagnose, hard to talk about. Mm. You know, we, we all are like, we all know what we are experiencing, but you know, your sister may have a completely different.

Dr. Haver: Constellation of symptoms associated with her menopause. Therefore, we kind of, as human beings kind of negate, you know, we gaslight ourselves, you know? Yeah. Or we, we dismiss what she's going through that can't be menopause because I had this, and we have to realize we are all really unique here on how we're gonna experience this.

Alicia Sutton: Very much so. Even then thinking about, cuz I was thinking about is my menopause was it, obviously it wasn't gonna be as similar as, as my mom or, or, or her mom. But, you know, looking at patterns in family history of, of where these things may or may not fall, like you're saying, if people in your family. Get menopause early, is it?

Alicia Sutton: Yes. More likely that your menopause is gonna be early? I,

Dr. Haver: yes, because there's a big genetic component as to when we go through menopause. It's a combination of genetic and environmental. And so you're half your mom, you're ha you know, you have the same, you share these genes. Um, but don't forget to look at your grandmother on your paternal side and that side of the family, cuz you have half of those genes.

Dr. Haver: Coming from the paternal side as well. So a history of your family members, especially a sister going through menopause early makes you more likely. It's not a hundred percent by any means, but these are like things to be aware of and those of us who go through menopause at a younger age, either naturally or through surgery or chemo or whatever reason, or premature ovarian insufficiency, you really have to be on high alert cuz you are at higher risk for certain diseases and you can actually mitigate those risks with.

Dr. Haver: Nutrition, exercise, pharmacology, you know, all the things. But like so many women or like if I would have known, yeah, I would have X and that I feel like is my job. I'm telling you, I'm not trying to be an alarmist or whatever, but I don't ever want anyone who listens to me on social media or comes to my office to be like, God, if I would've known, I would've done this differently.

Alicia Sutton: And I think that's where we all are, because even now looking back, I'm like, God, if I had known that there would've been a lot of things that I would've done differently. The things that I'm doing now, clearly I would've done, you know, uh, much, much earlier in terms of, uh, how I treat my body, how I'm eating food, what am I looking at, what should I be looking for?

Alicia Sutton: And at least kind of give you some kind of a gauge as to what to do. And that's why this show is so important is because we'll capture some of those women who will go, ah, Okay, well maybe I can do that. Maybe that is what's going on with me. Maybe I'm not just grumpy, you know, maybe I'm not just drying up.

Alicia Sutton: Something's actually a physiological change is occurring in women, and it's finally coming online that people are actually having this discussion that's so important, which. Takes me into another one. And I have some audience questions as well that I wanna get into, but I, but I have to touch on this because, you know, we're, we're getting older and, and such, and it's about vaginal health and I always kind of think, you know what, your vagina knows all your secrets.

Alicia Sutton: And even as, as we age, it still has needs. And you know, we hear the complaints about the dryness, painful sexual intercourse and things like that. Those are kind of common, but we're talking about potential health risks as well that may be attributed to these symptoms that need to be taken care of.

Dr. Haver: So, um, we have this kind of constellation of symptoms that happens in the pelvis and now, um, the governing bodies have lumped them all together and I think it was a good idea into something called genital urinary syndrome of menopause.

Dr. Haver: G s m. So when you hear us as transitions, talking about G S M, it is everything from the pubic bone to the coys. Mm-hmm. So, you know, the urethra, the bladder, the uretal, orifice, all of the tissues of the vagina and vulva that the entire length of the vagina, you know, including the perineum, all the. Skin involved and all of it has estrogen receptors.

Dr. Haver: And when we lose that estrogen, we see a decline of the health of those tissues. So specifically in the vagina, it becomes thinner, it becomes less elastic, it becomes very prone to injury and in illness, same with the urethra. And so we see an increase in, in urinary tract infections, an increase in vaginal infections, an increase in vaginal pain with intercourse or any activity in the area.

Dr. Haver: And the treatment. The absolute gold standard treatment of choice, even in recurrent urinary tract infections is vaginal estrogen, which is actually safe and FK for every single, even you who've had, you know, with a yes. With the risk, genetic risk, there's no association because the vaginal estrogen dose is so low.

Dr. Haver: No association whatsoever with breast cancer risk increase. Four blood clots. Wow. So almost every single woman can take vaginal estrogen, utilize vaginal, estrogen safely. And it is something I recommend constantly. And it is something that if once you have vaginal atrophy, so hot flashes will go away eventually.

Dr. Haver: It may take 12 years. Yeah. But it did. No, they

Alicia Sutton: will

Dr. Haver: eventually, more general urinary health will never get better. And as long as you wanna use those organs, you're gonna need vaginal estrogen as long as you are sexually active. Mm-hmm. And so that is not anything you're gonna, you're gonna treat real fast and it's gonna go away.

Dr. Haver: This is a maintenance medication to keep that tissue healthy so you can use it.

Alicia Sutton: You know, there's a lot out there, you know, in the world of the internet about some of these issues. And I'm not gonna even mention some of the stuff that I've come across, but is there anything that you could generally recommend?

Alicia Sutton: Staying away from, oh,

Dr. Haver: if it seems too good to be true, it probably is. It probably I F Y P is. Full of medical claims of vitamins and supplements and, you know. Yeah. And I'm a, I'm a person who takes supplements. I actually sell some supplements on our website, but I'm the first to tell you that no supplement is gonna cure your menopause.

Dr. Haver: First of all, if you see that, if it's gonna magically melt your weight gain, if your sex life, if you're gonna, one I saw was that my friends' husbands are jealous of my new sex life with a vitamin. That is absolute, that's never gonna happen, and that is never gonna happen.

Alicia Sutton: That is, that's crazy.

Dr. Haver: So if it seems good to be true, it probably is.

Dr. Haver: Look at the credentials of the person who is telling you this. Okay? If it's not a human being talking, that's a red flag. Number two, if they have no credentials, usually in their Instagram, their TikTok or whatever, you'll see 'em like mine says. Facog Bella of the American College of OBGYN doesn't make me a perfect provider, but at least I have some authority here, right?

Dr. Haver: The second is, are they recommending something in place of what is like F FDA recommended, and if so, are they making money off of it? Are they trying to sell you something? Are they telling you something so that they can sell you something? That's a red flag as well? And so I was just, buyer beware. Buyer beware.

Dr. Haver: You know, there's so much out there that the world has recognized, savvy, the entrepreneurs have recognized that there is a pain point around menopause. That women Yes, are, are needing help, are willing to pay for help, are looking for help. And so people who do not have your best interest at heart and are not using evidence, are making bold claims that are not being counteracted online.

Dr. Haver: Basically can say anything on the internet for a while. Yeah. And they're just trying to get your money to sell you something. And it's never gonna work. And then you'll be even more frustrated than you ever were before and broke. Right. And

Alicia Sutton: broke and broke and still in menopause. And your vagina's still dry.

Alicia Sutton: So yeah, it's just not gonna, that was perfect advice. I'm gonna leave it just with that, just with that, um, I had some audience questions that I'd like to go over with you. And the first one is, and I think we've touched on it a little bit and maybe just gonna expand on it. The first one is from, uh, Kai from Linwood, California, and she wants to know what are your thoughts on hormone therapy and the risk of cancer in aging women?

Alicia Sutton: So

Dr. Haver: it turns out that estrogen alone is not a risk factor for breast cancer above your baseline. And that women's health initiative, the women who took estrogen plus a progestin, and this was specifically equine conjugated estrogens, which is Premarin, which I don't prescribe, not because of that, because I have ethical.

Dr. Haver: I do not likely to the horses, it comes from pregnant horse urine. And I, I don't think it's ethical what they do to the horses to get the urine. So, um, I have great options, great options available to patients that don't include the torture of a pregnant mare. So, and then, um, the progestin in it, there was only one progestin studied.

Dr. Haver: It is synthetic. Not that all synthetics are bad. I'm not trying to. To negate that, but the, the increased risk for women who were young in their menopause journey, who took the estrogen progesterone together, went from about 3.2%, which was the baseline to 3.8%. That's it. Good. That's it. So you get to decide.

Dr. Haver: It's a shared decision making between you and your provider, but I don't think most providers are educated as on these exact statistics. Mm-hmm. I wasn't, you know, I was not a great menopause provider for a very long time. I just kind of went with the status quo. That was the status quo for 20 years.

Dr. Haver: American Board of OBGYN never put new menopause articles in front of me. You know, they had lots of great articles I had to read, but very little new information about menopause. Right. And so it really took me digging and, and looking for answers and realizing there's a ton of great information out there that no one's talking about.

Dr. Haver: No one's sharing because of the fear, because of 20 years of just this mantra being repeated over and over again until people thought it was true. And it turned out it's, the whole thing's been walked back and reevaluated and turned out not to be true. Wow. So there's very little risk. For the doses in FDA-approved hormone replacement therapy.

Dr. Haver: I don't know what they're putting in compounded things. I don't know what are in those pellets, so I cannot speak to those. But for something approved by the fda, at least the things that I prescribe, the risk of estrogen alone, if you don't have a uterus or having a marina, i u d is zero above your baseline and it's very tiny increase over.

Dr. Haver: If you need to take a progesterone as well, that

Alicia Sutton: is so different from what, like you said, over the last few years from what I was informed of 10 years ago, very different.

Dr. Haver: So that's not talking about endogenous estrogen and having your ovaries removed, that is still recommended. Okay. However, I just just did a webinar with Dr.

Dr. Haver: Men. Mm-hmm. Who's with Alloy Health. She had breast cancer at 28 years old. She was in residency, she had all the surgeries, everything done, and she's absolutely fine. And she is on very low dose hormone replacement therapy for the health benefits because she's at higher risk. So even you Yeah. Could consider a low dose es you, you've had a hysterectomy as well if they, they did the Uber?

Alicia Sutton: No, just the Uber ectomy.

Dr. Haver: Okay, so you'd need a Progestin or an i u D, and so that is something you absolutely could consider. Sharon Malone also, she's, she's the medical director for Alloy Health. One of the most eloquent speakers I've ever heard on this subject. Her sister and her mother had breast cancer, and she is choosing hormone therapy based on her own risk.

Dr. Haver: Her own risk tolerance. Yes, and knowing what the health benefits could be. So it's worth a conversation. You may choose not to do it right, but I think every woman regardless re deserves the conversation and that is something that has changed in the last few years, and

Alicia Sutton: that is absolutely necessary. Oh wow.

Alicia Sutton: Thank you for that. I have a couple more questions. The next one, this is from uh, Ayesha, a Rancho Cucamunga, California, and she asked, how can I maintain sexual health and wellness after a hysterectomy and breast cancer

Dr. Haver: treatments? Okay, so like we said, um, the best treatment to maintain your vaginal health after menopause is going to be vaginal estrogen, and there's no increased risk for breast cancer over baseline or blood clots.

Dr. Haver: So you definitely would and could be a candidate. There's some selective estrogen reuptake, modulator serum that are considered to be. Safer for breast cancer and vaginal health, but, but again, they're very expensive and other than, you know, plain estradiol, which is what most of us recommend, right? She should be a really good candidate for that.

Alicia Sutton: Okay, good. Let's see the next one here. This is from Katrina Outta Dallas, Texas, and she writes, what types of birth control method methods are best for hormone balance? And depress, oh, depressive symptoms in aging women.

Dr. Haver: Okay. So we know that women who are treated for, they're treated during perimenopause with hormone therapy in the form of a birth control pill or, or birth control, hormonal birth control, or in menopausal therapy doses have less new onset depression.

Dr. Haver: So you are more likely wow, to have a new diagnosis of depression if you are not treated in perimenopause. That is proven. And so I, whatever one that you tolerate, uh, for my patients, I go very low dose. Yeah. You know, which is still higher than menopause therapy. The biggest difference between birth control, pill and menopause hormone therapy is dosage.

Dr. Haver: And we need much lower doses in menopause to get the symptomatic relief, to get the bone strength, to get all the health benefits Right. Then we would, and the whole purpose of a birth control pill was developed was to suppress ovulation. No egg, no baby. For contraception. So now the pills range from 50 mics.

Dr. Haver: No one takes those anymore to 35, 30, 25, 20 and now 10. So most of my patients I do somewhere 10 to 20 for in perimenopause. If we decide that this option's gonna be better, I usually do that in early perimenopause. So that would be like a low estrin, sometimes a yes, I like ya cuz the sperone has. Some better, uh, emotional side effects.

Dr. Haver: Really, I kind of tailor it based on her side effects, her symptoms, how she's feeling, okay, but it will decrease her risk. It does not mean that you don't need an S S R I if you develop depression or other therapeutic options. Um, but for S S R I, resistant depression hormone therapy has been shown to be helpful.

Alicia Sutton: Oh, that's wonderful. Oh, that's great. That's great. All right, a couple more. And this is from, uh, Keisha in Los Angeles, California. What types of tests should women be taking at various stages in our lives, forties, fifties, sixties and beyond? That's a good question.

Dr. Haver: So there are well-published guidelines on what we call the well woman exam, or the annual health exam is probably a better way to say it.

Dr. Haver: And so depending on your age and your preexisting risk factors, things like a blood count, C B C A, you know, cholesterol lipid panel after age 40, thyroid screening for thyroid disease. You know, if she's asymptomatic. So there's tests that we do. If you're just going in healthy, I have no problems, no issues, no worries.

Dr. Haver: And we're just screening for things you don't feel yet. Right, right, right. And then there's other tests that we order. You're like, you know, I'm, I'm okay, but I'm really tired. Like I'm really struggling. I've got some constipation. My skin's really dry. Okay. Thyroid, boom, we gotta check that. And so in my clinic, And I have a blog about this on our website.

Dr. Haver: So our website's, galveston diet.com, and I have a, a blog all about tests to maximize your annual visit. Okay. And it talks about symptoms and like what if you're having symptoms, what symptoms to make sure you're mentioning to your healthcare provider so that they can document them and get these tests paid for it by insurance.

Dr. Haver: And so I. You know, when I have someone who I think is perimenopausal or early menopausal, I'm rarely running hormone levels. I, I can diagnose menopause by talking to a patient. You don't need extensive, expensive oral, saliva, urine, P on sticks. Right. Right. I can diagnose perimenopause by talking to a patient.

Dr. Haver: What I am doing blood work for is making sure a lot of these symptoms overlap in multiple diseases. So I wanna make sure, is this lupus? Mm. Is this another autoimmune disease? Is this hypothyroidism? Okay, is she have a vitamin deficiency? What's her D doing? Is she armed deficient? So those are the blood tests that I am focusing on, and I do, and I, is she inflamed?

Dr. Haver: I'm looking at chronic inflammatory markers. Now those can be non-specific. They're a little controversial, but I like to follow them if I'm treating someone nutritionally for inflammation. And so those are the things and I talk about them in the block.

Alicia Sutton: Wonderful, wonderful. And one last question. And I got this question and it came with, uh, a lot of exclamation points, so I wanna kind of say it the way she said it.

Alicia Sutton: Uh, this is from, uh, Latrice in Los Angeles, California. How can women in menopause stop waking up drench with sweat from night sweats? Question mark, exclamation, exclamation.

Dr. Haver: The gold standard of of treatment for hot flashes, disrupted sleep, and night sweats is gonna be estrogen. Systemic estrogen therapy, either a pill, which is not my favorite, or transdermal, transdermal estrogen, would be in the form of a patch, which is what I usually prescribe, or a gel or a cream.

Dr. Haver: It bypasses the liver when you go through the skin so that you don't have an increase in clotting factors. So the theoretical increased risk of blood clots goes back to your baseline by doing a transdermal option. That's all. Nothing wrong with oral outside of that, and the risk is minimal. It's only seven per 10,000 women.

Dr. Haver: But you know, I have options, so I tend to try to just push people to the safest one, you know? Right. If she can't, if she has a rash with a patch or it just won't stick to her, then we go back to oral knowing there's that little tiny increased risk. But people tolerate it fine. So yeah, that is going to be the best thing.

Dr. Haver: Now, if you cannot take it or you choose not to take it, it's a little tougher. We have to go symptom to symptoms. So again, Clonidine will help with the hot flashes. Neurontin helps. Those are my kind of my top two that I go for for that. There's some. Supplements that might be helpful. Turmeric is one.

Dr. Haver: Making sure you have plenty of fiber in your diet, making sure you are exercising on a regular basis, making sure you're not going over 25 grams of added sugar per day. Uh, probiotics have been shown to be helpful, so anything you can do to keep your gut microbiome healthy and keep your blood sugar stable is gonna be helpful.

Alicia Sutton: It's a lot. Well,

Dr. Haver: it, you know, when we talk about chronic disease, it's rarely one thing that causes you to get X, Y, and Z. It's the Swiss cheese right Theory, right? The holes have to line up, and the more holes you have, the more likely you can get an arrow all the way through. And so it's the same thing.

Dr. Haver: You know, it's like you can't just say, oh, I'm gonna take this one pill or this one supplement, or do this one thing and continue on with all my other habits that are pointing me towards that disease state. Right? You have to hit it in multiple different directions so that you can be as healthy as

Alicia Sutton: possible.

Alicia Sutton: Is there any issue with taking, uh, things over a period of time? Are there. Times where, you know, if, if you're taking the estrogen therapy and, and some of the other medications you've mentioned, is there a time where you need to like, take a break from it? Or is it something

Dr. Haver: that you can No, there's no age at which you have to stop hormone therapy if you're doing well on it.

Dr. Haver: Okay. Take that off the table. But there is something called the healthy cell theory or the the timing hypothesis. And basically for a couple of disease states, especially cardiovascular disease and neurodegenerative disease like Alzheimer's and dementia. Mm-hmm. Having estrogen, not having a gap in estrogen.

Dr. Haver: So being on estrogen as soon as possible will decrease your risk of developing these diseases, both heart disease, Alzheimer's, and dementia. Okay. Especially in high risk Alzheimer's patients. Oh, wow. However, if you start later, like at five to 10 years after the onset of your menopause, you will lose those benefits.

Dr. Haver: And at least in brain disease and some cardiovascular disease, you might actually make it worse. Mm-hmm. So I have a conversation with my patients who are. Older and coming to me curious about mental, you know, and they've never been offered or they've chosen not to earlier and now they're wanting to learn more about it.

Dr. Haver: If they have their cardiac calcium score and it's elevated or they have risk, you know, we have known, know that they're on their way to cardiovascular disease, they may not be a good candidate or. I have one patient, she had been menopausal for 10 years, never got offered it. And her mom, she's a very significant family history of Alzheimer's.

Dr. Haver: Yeah. And so more likely she's got some genetic something going on. And we made the difficult choice for her because of the possible increased risk. And that's her biggest fear is not being able to. Think. Right. And she's a really young woman, and so I'm like, look, you know, we're, we're, it's a little risky here.

Dr. Haver: I don't have a lot of data and it's looking like we may make something that's been, the ground's been laid for you genetically worse over time, so let's maximize Wow. All the other things we talked about. Oh wow.

Alicia Sutton: That is very good information to have, uh, for our audience and people picking this up later in life, because like you mentioned before, sometimes it just, it was just never offered.

Alicia Sutton: It was just, Not something you even knew you had an option for, or the information

Dr. Haver: wasn't accurate that was available at the time has been disproven, so we kind of left a whole generation of women bereft. Yeah. And I, I can't fix that, but what I can do is move forward and at least the next generation, we can give them a lot better information.

Alicia Sutton: And I'm all for that. I'm all for that. Making that, uh, intergenerational gap kind of mending us together. Are there any other, uh, thoughts? I mean, we, we've covered a lot here. Um, we've got a lot of information in a short period of time, and I just wanna know if you had any other, any final thoughts, anything else that you wanna kind of leave us with?

Alicia Sutton: And also, where can my audience find you, find your blog and, and get more information? One of

Dr. Haver: the things is that there are estrogen receptors. On every organ system of our body and so many things we are discovering in the last five years, like since covid, that are actually related to menopause that we never realized before.

Dr. Haver: Musculoskeletal disease, frozen shoulder and capsulitis, chronic inflammatory conditions, tinnitus, dizziness, mental health disorders, adult, A D H, ADHD, onset, you know, all of this has. An estrogen component. Estrogen tends to be protective for these diseases. So if something's changed with you, you're in your thirties and forties and you, you have not changed your diet and exercise, you cannot put your finger on it.

Dr. Haver: You better be a, have it on your radar that this could be menopause related. Right. The second thing is you don't have to suffer. Like there's some kind of a, a thought that we have to suck it up and knuckle through it and, and be brave and no. You know, the more, like you, you were talking about earlier, you were so proud of yourself that you could just blitz through the night.

Dr. Haver: Oh yeah. What were you doing to yourself long term? We do that to ourselves all the time. And if you wanna be healthy and be able to take care of yourself and you know, my big goal is I don't want my girls. To feel about me for as long as I have to about my mother. You know, um, mama's still alive, but watching my parents in these chronic long-term health conditions that are just wearing them down over years and years and years.

Dr. Haver: I don't expect my mom to live forever, and I don't expect to live forever, but I don't want my long-term chronic disease that may have been avoidable to have my children be worried and suffering and having to disrupt their lives to come take care of me. I don't want that, and that is my goal. That

Alicia Sutton: is absolutely wonderful and I can't think of a better way to wrap this session.

Alicia Sutton: And thank you so much for being with us. I know you're very busy and you've taking time out for us and my, my little podcast here means so much to me and I thank you and appreciate you. You're welcome. And I'm grateful for having you here today. Thank you so much. Thank you for listening to 50 Now. What?

Alicia Sutton: Make sure to follow us. Rate and share the show. Make sure to follow me on Instagram for continuous updates at 50. Now what podcast? That's five zero. Now what podcast? Make sure to tune in on May 26th for our episode featuring Amanda Jagger. We talk about what it's like to make friends in your fifties iss it time for that girls trip.

Alicia Sutton: Learn about the value of relationships and so much more. We can't wait for you to check it out. This podcast was produced by Rainbow Creative with producer Matthew Jones and producer and editor Sean Levy Feely. I love working with this team. To learn more about making a podcast for you or your business, visit them@rainbowcreative.com.