This is an iHeart podcast. Guaranteed human. Nothing beats a Jet 2 holiday. Right now, we've got some great deals available. Plus, you'll get the best choice of rooms and hotels. Book now with just a £60 deposit per person. Get 22kg of baggage included and go direct from London Gatwick. Nothing beats a Jet 2 holiday. Package holidays you can trust after a night of protected, subject to availability conditions. Hey everyone, it's Sophia. Welcome to Work in Progress. Welcome back to Work in Progress Whip Smarties. We are back with Dr. Mary Claire Haver for a special dive into her new book. The new perimenopause is officially out in the world. We're thrilled you're here. You're one of the preeminent authorities on women's health and you really are making sure women's health stops being a brown paper bag bottom shelf conversation in the American medical system, so thank you. We know that women experience real biological changes, all of us at some point, that medicine has been really slow to recognize or properly treat and you talk about this in the second chapter of the book, Zone of Chaos, why for our friends at home? Why has perimenopause remained this blind spot for so long? I, well, when we look at women's health funding in general, of in 2023, the NIH, so when we look at who funds research, right, it's the National Institutes of Health, Pharma that get their medications through and private companies. Okay, so right now NIH, you know, things are changing rapidly and I don't know what's going to happen there. It's not prioritized, so, you know, so now, but we're also seeing the greatest transfer of wealth to women in the history of the world and women don't build rockets or buy yachts, they invest in health. In other women, shocker. Melinda Gates, huge, $100 million, you know, we look at the CARE foundation, we look at McKinsey Scott, you know, like Mrs. Walton, Alice, I think, just built a medical school for the underserved. So, you know, that's what women do. So like, I'm very, very, very hopeful in that sector and like my husband and I just started a foundation to fund women's health, you know, like clinically relevant menopause research. So that's what we want to do. We're not in by, you know, building a rocket. And so, so that's exciting. NIH, I don't know what's going to happen. It's not looking that great right now. So, but in 2023, we had a $43 billion budget, right? 15% of that went to women's health. The vast majority of that went to pregnancy, which is important, but it's not the only thing and rest in ovarian cancer. Okay. Less than 1% of that budget, not of the total budget went to menopause. Right. So now I'm going to like go to PubMed and put in the word pregnancy. Give me every article ever written of like great medical journals that mention the word pregnancy and it's about 1.2 million. Okay. That represents brain power, money, funding, studies, back office staff, you know, all the things, patient recruitment. Okay. Now I'm going to type in the word menopause and right now it's about 99,000. So 12 to 1. Wow. More women will go through menopause than have children. Right. Okay. Perry menopause has 9,000. Stop. Not one word mentioned about Perry menopause until 1977. Yeah. It was not a thing. It wasn't even recognized as a transition until 1977. Wow. And so when we spoke last time about how women are often dismissed, oh, she's emotional. Oh, she's a little crazy. Oh, she has a short fuse, whatever. The idea that this thing that literally happens to all of us. And when I think about the math, okay, hold on. Yes. We got 15% of the NIH budget, but we're 51% of the population. 1% of 15% was dedicated to menopause, even though 100% of 51% of the population will go through it. Like it just... So it's so stupid. Like it's all performative, right? So the last administration said, oh, we're going to do $100 million of new funding for women's health. Okay. Of 43 billion, do the math, 100 million. Everyone comes to the table. Indometriosis, polycystic ovarian syndrome, all the auto-indicities that primarily affect women. Rheumatoid arthritis, you know, and everyone's like, give me a colonel. You know, and it's not enough. It's not enough. I feel like RBG, like when they're nine, like until we get all the funding for 20 years and then we'll dole them out to men when we feel like it. Yeah, to catch up. Because by the way, they're doing just fine. I mean, there are issues there too, but I only take care of women, so I only focus on that. I guess I mean in the balance of the scales, you're correct. Sometimes I say things very hyperbolically and then people get mad at me and I'm like, isn't it obvious what I think? But I realize, no, you have to be very specific all the time. You know this, you're a doctor. I just am so fascinated by this because the gaps, the chasms in the funding mean there are chasms in how we're taking care of. And I really appreciate it in the fifth chapter in the book. You talk about how the mental health shifts can come first. And when you consider system overwhelm, like if your computer's doing too many things at once, it'll crash. Right. Our brains are not dissimilar. And you talk in the fifth chapter of the new perimenopause about how perimenopause can actually trigger these mental health experiences like depression, anxiety, so many women will say, I don't know what's wrong with me. I don't feel like myself. All the things I do, I just can't do them anymore. How do you help people identify mood changes and rather than feel like it's some sort of personal failure, understand it's part of their biological evolution? We talk about when's the last time you didn't feel this way. Tell me about that, Mary Claire. You know, tell me about that, Sophia. When did you have all this managed? So like walk me through the transition for where you are today to where you were. And we try to look for triggers like, you know, did your dad die? Did you lose your job? Are you fighting with your spouse? Are you, you know, with your partner? Are you are the kids going through, you know, their hormone changes at the same time, which is so unfair, so unfair. So, you know, are you in a big sandwich generation? And oftentimes it's let's do a trial of hormone therapy and see if you get better. The data out of Australia is clear. If it is new onset, anxiety or depression, which she was totally fine before, starting her on menopause hormone therapy in parody menopause has better outcomes than starting her on an SSRI. If she was on an SSRI and doing great, like she's had a years long history well managed with her medications, all of a sudden she's breaking through. The symptoms are back. Start her, don't add a dose or increase yet. Try, good, do a trial of hormone therapy first. Wow. These women and it's going to make a huge difference. Wow. You know, you talk about what you wish you'd known at 35. And so when you talk about this, that shift, because to your point, someone might have been on an SSRI since college and been crushing and then suddenly feel like she's drowning. And I imagine that might happen around 35 or 40. So, so what, what would you put on that list for any women in that age range, you know, who are around 35 who are listening to us talk today? What do you want them to know now so they don't have to learn what they wish they'd known at 35 at 45? Listen, educate yourself as much as possible about this process and all the organisms that could be affected. Not everything is menopause or perimenopause, but we're missing so much of what, what is and women are suffering needlessly when we have multiple ways to support you through this, but you're going to need to find a menopause educated clinician and they're not easy to find. And so, you know, it's going to take some hustle, you know, it's going to take some reading, it's going to take some self-evaluation, but we've got tools for you and you do not have to suffer. You can live your best life. Yeah. Now you mentioned in our, in our last chat that you analyze everything from, you know, your ferritin levels to vitamin D to how active you're being. Are there things that you think just universally track for women? Like I've, I've, I've spoken to some other medical professionals who say supplementing vitamin D and magnesium before bed can be two of the quickest things you can do that'll change your life. I agree. Okay. From a, you know, mag. Bisclicinate is great at relaxing the body. So that's why it works so well before bed. And like full disclosure, I have a supplement company. We sell a sleep product that contains max. So take it with a grain of salt. You can get this stuff anywhere. But we also have healthy anine, which is a natural anti-anxiety kind of stops those helps to stop the racing thoughts, you know, mixed together. But 80% of our patients are vitamin D low or deficient. And, you know, optimal is not the same as deficient. And so for a healthy patient, you really want her to be above 60 to 100 ish and her vitamin D, her serum vitamin D level. Mag, if you're going to do a magnesium level, you want an intracelular, like intra red blood cell magnesium. That's more of what your stores are rather than what's floating around the blood because that blood that can fluctuate the serum level. If you like ferritin is such a great way to see what your iron stores are doing. It's the first thing to go when we're dealing with iron deficiencies. You really want a ferritin level. So, but if you're just, I'm going to say, OK, take one thing you can safely take up to 4,000 I use of vitamin D a day without worries of toxicity. So start there. Yeah. Track your nutrition just for a week. Don't be crazy about it. How much fiber are you getting? How much vitamin D are you getting? How much magnesium are you getting? So many of us, the average American woman is getting 10 to 12 grams of fiber in her diet per day for gut health. It's a minimum of 25. For cardiovascular, it's 35. So that is an easy thing up that fiber in your diet. It's not seeds, legumes, a fiber supplement, you know, to get you over the hump if you need it. Wow. See, little things like that that would probably change the way we all feel in our bodies every day that we don't even know to start with. Yeah. So thank you. You're welcome. I'm excited about the fact that your approach is so holistic and frankly, that that you wrote us a book because, you know, you do have a clinic, but you can't see every woman in the world. I can't. But every one of us can can read the book to be better prepared or to cope with current symptoms of peri or menopause. I I'm just thrilled to have been able to have this conversation with you and to get to see your face, even though we're not together personally. Friends, the new peri menopause by Dr. Marie Claire Haver is out now. Congratulations on another fantastic book. And and thank you for writing this for us. Thank you. Thanks for having me. Rural Britain, you've suffered too long. Your days of sluggish broadband are over. We're connecting rural homes to full fiber with thousands more joining every month. 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