Dr. Mary Claire Haver

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Light weight, fast absorbing and trusted to do what your skin needs. No fuss, no compromise. Just soft, smooth, healthy looking skin every day. Grab your E45 lotion now. Hey everyone, it's Sophia. Welcome to Work in Progress. Welcome back to Work in Progress friends. Today we are joined by a doctor who I am just so inspired by because she's managing to make very complex science that affects all of us ladies feel like something we can tackle together. By 2030, more than a billion women worldwide will be postmenopausal. Yet for most of modern medicine, menopause has been treated like an afterthought. Women struggle with symptoms from sleep disruption and brain fog to metabolic shifts and cardiovascular risk. Yet most doctors receive little to no training in menopause care, leaving millions of us to navigate this transition with limited or no guidance. And while you might not be in menopause, are you in perimenopause? Do you know? Do any of us know? How do we know? Nobody tells us anything. But Dr. Mary Claire Haver is here to help tell us what we need to know indeed. She's among a group of physicians that is really working to change our experience with this part of life that all of us go through. She's a board certified OBGYN. She's a certified menopause practitioner, and she has become one of the most widely followed educators in midlife women's health. Her bestselling book, The New Menopause, ignited a broader public conversation about the stage of life and its follow up. Her latest, The New Perry Menopause, turns attention to the earlier, least understood and most disruptive phase of the transition. Fun fact, she also was involved in producing balance with our work in progress friend, Jeannie Mai, who you heard from earlier this year. We're going to talk all things women's health, how we take care of ourselves, how we even know where to start and what she's learned along the way. Dr. Mary Claire Haver is here with us. I'm just so excited that you're here. We got a little bit of time together. I can't believe it's almost been a year and a half now. Year and a half, yeah. At the, it would have been the 2024 big live hello sunshine event. And you came to speak to all these women about kind of the wild west of our bodies, right? Like we're 51% of the population on earth, but for some reason we barely get studied. We don't get many medical research dollars. And we all hit a point in life, whether it's pre or postpartum or pre or during menopause where doctors basically say, oh, that's just part of aging as a woman. Meanwhile, the men don't have to do that. So I'm just so excited that you are here to talk us through some of this before we jump into, you know, present day and your, your history as a doctor, though, I want to go back in time a little bit because particularly, I think so many of the guests on the show are these impressive people with these impressive careers. And so many women and especially young women I interact with are wondering how to know what they're destined for or if they're on the right path. So I always like to ask the impressive women I sit with. If you got to go back in time and interact with your younger self, you know, little you at eight or nine or 10 years old, would you see, like, would you see aspects of the woman you are today in her? Do you think she'd recognize herself in you? No. No, not at all. No, I was brought up in South Louisiana. I'm one of eight kids and my mom and dad are great. I love them. However, they just wanted me to marry well. Like that was the, and I did. So, you know, I did hit the marriage lottery, but like they weren't concerned about me having a career or going to college. I mean, my mother went for a year for secretarial science at 18, but my dad got married at 19, you know, and they just kind of felt like that would be a path for me. I mean, my dad was like, she's pretty, so she'll be okay. You know, like, and not to like, not my parents, like they supported me studying, going to college and everything, but it was like marking time until I met my husband. So, you know, going to college would give me a chance to meet a person who also went to college who, you know, take care of me for the rest of my life. So that just wasn't in their realm of thought, you know? Wow. And so eight year old Mary Claire, nine year old Mary Claire wanted to be a ballerina or a cheerleader or an actor, you know, and so I kind of thought about nursing somewhere down the line because one of my aunts was a nurse, but it just, that wasn't, I wasn't smart. Like I did not like blow the top off of high school. I was an average student. I never applied myself. I showed up, you know, I was into drama and cheer, you know, for extra curricular activities. I was not an athlete. And then my parents went through bankruptcy right around my senior year of high school. They had to move to another state to try to start a new business. Everything got disrupted. And that is when like the lightning bolt of you have to figure this out. Like no one's coming to save you. And that's when I went to college, you know, totally at the local college in the town I grew up in, walked to school, didn't have a car. And just really buckled down and applied myself. And lo and behold, I was smart. Wow. Yeah. I mean, I made good grades. If I applied myself, I'd get an A. And I was like, this is cool. So, you know, all those dopamine hits, I just kept chasing the good grades. I think that's so interesting because, and look, the social aspect of school is great. I did all of it too and loved it. But isn't it funny that women have been historically encouraged to like go make friends, go be popular. Like you said, go find a really good guy. And the guys are supposed to be popular and get good grades and pursue a career. Right. You know, yes, find the right partner, but you better start a business. And it really does feel like our sort of peer group has been the sort of generation or two generations that have been shifting that. When you went from, you know, starting college, local school, walking to school, as you said, when was that LSU or did you transfer to LSU? No, it was it was it was called USL at the time. So it was in Lafayette, Louisiana. It's now ULL. So they've changed the name University of Louisiana at Lafayette. Most people know them as the Raging Cajuns because we have a really unique mascot. So it's actually the second biggest university in Louisiana. It just happened to be a mile from my house. You know, I was living. So and I had a great experience there. Like I my undergrad is geology. Eventually I changed three or four times, but I graduated in geology and went to work for an oil company for a year and a half before I met my husband and then went to medical school at LSU after that. Wow. So what was it? As you say, you know, it's a series of light bulb moments, right? Like nobody's coming to save you. You know, you you can. Yes, you can eventually marry well as you did, but you also kind of have to embody share and be like, mom, I am a rich man. Yeah, exactly. You got to be the one. I've got this. So what what was it that shifted you to obstetrics and gynecology? Like how did it happen? I started working. So, you know, like I was working part time for oil companies as an undergrad because of my degree path. And so I was getting a taste of what life would be like after. And I was coming to the realization of I don't think I want to do this long term, but I'm kind of stuck in this path and I'm very close and I have all these scholarships, like let me just get the degree and figure this out. And so. I graduated, got a scholarship to go study geology for a semester in New Zealand. So it kind of pulled me away from everybody and expectations. And I had this incredible adventure in New Zealand. And while I was down there, that was my like, I don't want to do this forever. Like this was cool. I love the math and the science and the, you know, I love the rocks, but I don't want this to be my career. And so my host family were all doctors and they were like, you should think about medicine with their New Zealand accent, Kiwi accent. And I was like, really? And they're like, well, you obviously can do math and science. Like this is, you know, does it interest you? I'm like, yeah, it always kind of has. And they're like, take the MCAT, see what happens. And so I went, you know, finished that, went back to the U.S. I was going to start a PhD in geology, turned that down, went to work, because I had to eat and, you know, was meeting my husband while I was taking the MCAT and applying to medical school all of the same. Wow. What a trip. So, OK, we fast forward and you're in the OBG world. Yeah. Do you. Do you. Was there a particular patient experience, like a pattern that you kept seeing that made you realize something important was overlooked? Yes. And it but it wasn't until much later. And so I had imposter syndrome. I probably still have it, right? We I think we all do. I was in medical school waiting to be tapped on the shoulder to say, we've made a mistake, you know, you shouldn't actually been here. So I was like, and even in my residency, I was a yes girl. I did everything right. I blew the top off my boards. I won a war. You know, I was like, yes, yes, yes, yes, yes, yes. Just going flat out would never question the system. Never. Like I wasn't that girl. And so it took getting out, going into clinical practice and really getting to know my patients. You know, so I was so fortunate to work in a small town with a huge medical center and so many of my patients were my friends, my neighbors, my mom group friends, we ran marathons, we had, you know, wine nights we had. And then like all of the researchers at the university were my patients, too. So I I know these women. I know their lifestyles. I know. And all of a sudden we're aging, we're aging together. We had babies together and then we're raising kids together. And now we're going through perimenopause together. And like the wheels are coming off the bus for all of these women, almost all of them. And that's when the pattern recognition started, like something's not right. Something's not right. Something's not right. And I like because I know them. I know their habits. I know the intimacies of their lives. I've been taking care of these women for 10, 15 years now. And something is external to her, you know, what actually was internal. But like not everyone's going nuts at the same time, you know, right? And these are women who had built incredible lives, complicated lives, but they were managing them. Right. And then all of a sudden they'd lost their resilience. So that's when and then it happened to me. And so that's when I was like lightning bolt, something's going on. We're not doing this right. And I started doing deeper dives into the science and literature and realized there's data out there, but no one's connecting the dots. Right. Well, and one of the things I've learned from folks like you and other friends of mine in the world of sciences is that there is so little training in medical school about women's health and this time in life specifically. Yes. And so in a way, you as a doctor have to be a figurative fisherman. Like you've got to go out and catch all the fish and then look at them yourself. And it's like, well, if we know this is the pattern, why isn't it in the books? Like, why aren't we teaching everyone this stuff? So that's a great question. Not only are we not teaching the biologic predictability of what's happening with this massive hormonal change, we're also we're taught that women tend to be a little bit crazy. You know, the it's all in her head. They tend to somaticize psychological conditions. So it's a double edged sword. We're not teaching the actual biological truth. And then we're filling in that gap with, well, you know, this is just what women do at this age. You know, she's a little crazy. I mean, I laugh and call it the bitches be crazy school of medicine. I stole that from Elizabeth Cohen. But I love that. You know, like, you know, she's a little crazy. This is just her time, you know. I don't think it's a coincidence, though, that as women get wiser, much more independent, much more capable of saying no when we've been reared our whole lives in existence to say yes. That that's when they start to tell us we're crazy. And that's when they start to tell us we've we're out of our prime or we're not hot anymore. Like I look at the 50 year old women in my life and they're so hot and so smart and so successful and so chic. I'm just like speed up my clock. I'm ready to get there. And and I realize this whole societal thing is such a lie. And the lie coincides with a medical shift that they can dismiss us for. One of the most beautiful things I feel about the menopause transition is that women suddenly are able to peel back and focus on themselves. Like they're giving themselves permission and agency to prioritize themselves first because they have to write because no one's coming to save them. And and then you when you see that work for them and then they step into who they're meant to be. Instead of this person who's going to serve everyone else that they're like in like what do I need? What what is my priority? How am I going to be happy? It's it's the most incredible thing. And now a word from our sponsors who make this show possible. Sorry for the voice note. Just running for the taxi. Did anyone pack hair straighteners? No, I didn't. I've got hair straighteners. Everybody relax, pre-departure drink anyone? Sure, you can roam in the EU at no extra cost, but what really matters is friends and family. That's why we're happy to be your second most important network. Tesco Mobile, it pays to be connected. Terms apply. See tescomobile.com slash home from home. The shift I'm seeing in all the women I know in their 40s and 50s is incredible. I'm curious for you, you know, as an actual doctor, you know, we're all out here watching it happen. But you you know specifically what's happening. When you started to dig into the science, what surprised you the most about what was known and what still wasn't? So that there were estrogen receptors throughout the body. Like I had a pretty good idea of hot flashes. I didn't actually understand the neurokinin receptor and Kispeptin. And like now they've mapped out why we have hot flashes. But I was taught that women would. Due to menopause, OK, not just due to aging, have hot flashes and have cycle disruptions, which might be heavy periods and their generally urinary system would take a hit. Nothing about their skin, their and osteoporosis. Yes. But nothing about their muscles, their joints, their skin, the itchy ears, their mental health, the incredible hit our mental health takes, the brain fog, these sleep disruptions like that. That was all external to menopause. And when I saw the paper where they mapped the estrogen receptors, the G couple of estrogen receptors throughout the body, I literally like sat there and stared at it for an hour and was like, how did I not know this? I can't tell you how many times I have found a paper, found research, found an article, found a graph and thought, how did I not know this? Perry menopause. I thought the ovaries went through this gentle decline until they petered out at the end. No idea about the zone of chaos. And that paper was published in 1996. No. Oh my goodness. Okay. Can you can you walk our friends at home through this? Because for our people and and I'm going to really pick your brain on the latest book later. But for our friends at home, Dr. Mary Claire has written an incredible book. Your first is the new menopause, which I think really opened up a lot of eyes. And the second book I'm so excited because I got a copy too is the new Perry menopause. And to your point, it seems like Perry menopause is the word you hear on everybody's mouth lately, but we haven't known a ton about it. And what is this zone of chaos? I've heard it described not as the way you you said it, the idea that it's a steady decline, but it's more of a cliff that really disrupts our bodies. Is that accurate? Do you have a better way to put it for us? It's it's more of fluctuation. So let me let me explain. Let's go back to pre menopause before menopause enters the chat. OK, and a normal healthy woman who has regular cycles. So that's about 80 percent of us, right? Your population is driven by your brain, not your ovaries. The ovaries do not act autonomously unless there's a tumor or something. OK, though, we should sit there and wait for instructions. We females are born with all of our eggs supply. So if you're XX and everything's healthy and working like playing, you're born by the time you're born, you've got one to two million eggs. OK, that is your set for life. And then you are going to lose them all the way through puberty through a process called atresia. And then we're going to start ovulating. We'll lose a bunch to the ovulation process. So by the time we're 30, we're down to about 10 percent of our eggs supply roughly, and by the time we're 40, we're down to about 3 percent. And menopause, full menopause represents no more eggs. OK, so why do we ovulate? There is a command center in our brain called the hypothalamus. And just imagine it has a little finger measuring estradiol, the natural estrogen produced in our ovaries each month that ebbs and flows, right? Most women have seen the cycle where we peak estrogen, mid-cycle at ovulation. And then it peters off. When that drop off occurs, the brain's like, where's that estrogen going? I need it back. I want it back. And so it starts sending signals to a second gland called the pituitary, which pumps out something called LH and FSH. Those are two hormones that bind to the cells around the eggs that produce the sex hormones, estrogen, testosterone and progesterone. OK, so perimenopause begins when we reach a critical egg threshold level. We are down to X amount and that the signals coming from the brain don't work as well. The ovaries become resistant because there's not enough eggs to respond and recruit enough follicles to make enough hormones. OK, so they're they're going, oh, I better hold on to this. It's like a little stress response. So the brain is like, hey, I sent the signal, where's my estrogen? And the ovaries are like, we try, we just can't respond. So the brain flips out, starts pummeling the ovary with higher and higher levels of stimulating hormone until it can force those few eggs left to ovulate. So what happens is instead of that beautiful EKG 28 day, month after month curve in a premenopausal woman, you know, on day six, you're doing this on day 12, you're ovulating on day 18. Your progesterone is going to go up. Like it is so predictable month after month. Now it's like ovulation is delayed. You might have two ovulations in a 28 day cycle. Progesterone can never keep up. So it used to be very predictable looks like chaos. We end up with higher estradiol levels than we've had outside of pregnancy. You know, and so and then they crash. And so instead of this beautiful pattern, it's like crazy, crazy, crazy on the way down like a roller coaster all the way down until we run out of eggs. That becomes chaos. You know what doesn't like chaos? The brain. And so our neurotransmitters, how we if you look at Lisa Masconi's work, she mapped out estrogen receptors and glucose uptake and how we massively upregulate our estrogen receptors in at least the first 10 to 15 years of premenopausal menopause. Because the brain is like, I have to get estrogen. I need more receptors to grab whatever's floating around. And glucose uptake really becomes sporadic in the amygdala where our emotional centers are and also in the frontal lobes where we consolidate memories. So that is where the first signs of perimenopause typically are not cycle of regulation or not have flashes or I don't feel like myself. I'm not sleeping. I'm having new anxiety and depression. I'm having brain fog. So the brain is the first thing to signal that you're going through it. That is what we were never taught. That is still not being taught on a regular basis. So when women come in and complain of these things, no one knows what to do. Wow. Wow. I wish they could take portions of your book and just insert them into the medical textbooks, because clearly people need it. Now, I'm curious about this and one one little side note that makes me kind of giggle, you know, because as you said, we get dismissed, women get dismissed as being emotional or a little crazy. Or how could a woman lead when she's got all these hormones? And I remember it's been neat to see some men who are doing, you know, love love your love the women in your life, better content on the internet. And one guy made a video that made me giggle and he said, what women go through every month for for us hormonally would be aging 125 years one week out of the month every month. Like if you don't think these women have proven that they can lead, like we would die, men would die. And it really it really made me giggle because I thought, thank you so much for acknowledging that. My curiosity, because of what you're explaining and what you said earlier, women manage so well. You know, we we can really carry those full cups of water and they might spill a little bit, but we're we're really capable of carrying everybody's stuff. And then to your point, this shift happens. And suddenly there's more spillage. Yeah. How how do you recommend women start to take stock? Because, for example, you know, I'm curious about this stuff. I was kind of like, well, how do I know? And I had one doctor say to me, if you're asking if it's happening or not yet, it's not happening because you'd know. And I was like, that's the metric, like for real, that's the metric. So I found a new doctor started doing really regular testing all through my cycle. And it turns out my hormones are still in a pretty good pattern. They're in a great pattern. And they were like, sorry, if you're feeling anxious or your your brain fog is up, it might just be because the world's burning. Like you don't have an excuse yet. And I was like, damn it, I was kind of hoping I did. But but how do we know? Because the mystery feels tough. And I, you know, I want to acknowledge not everybody can go do regular testing like I can with my great health insurance. Right. So certainly if, you know, there's some really like standout things like if your cycles were regular and now they're not and you're having all these other symptoms, check. Yes. OK. But what if they're still regular? Right. Like you were that part. How do we know the difference? Testing, you know, blood testing is really, really hard. Like you said, it's very expensive. You have to do it multiple shifts throughout the month. Not everybody can afford that. That is not typical. What we do in our clinic is we look at the constellation of symptoms. We have a tracker. We have a scoring system that's been validated by the Australasian Menopause Society, looking at does she have brain fog and musculoskeletal pain and general urinary symptoms and blah, blah, blah, blah, blah, blah, blah. OK, now we're going to do blood work to rule out hypothyroidism, vitamin D deficiency, low ferritin, autoimmune, you know, like, like we're doing tons of blood work, not so much hormones for us. And I'm ruling out or in because all this can be happening at the same time. Like and then we have a frank discussion about we can do a trial of hormone therapy and see what gets better. OK. And then. We can talk about other, you know, forms of therapy and we never leave lifestyle out of it. So so many women find that the lifestyle they'd set up, which worked in your, you know, worked for a premenopausal woman. Suddenly, there's holes and gaps we're seeing that are, you know, you're not you're not actually optimized once your hormones start fluctuating. And what are the lifestyle changes that can kind of refill those holes? Well, nutrition is huge. OK. And so when we look at, you know, in our clinic, we're looking vitamin D. It's so hard to get enough through your through diet. You know, we're checking vitamin D levels and we're checking iron. We're looking in inflammatory markers like high reactive, high sensitivity, superactive protein, you know, like, what are we missing here? Why is she not able to live her best life? You know, when she was before, right? And there's no external stressors that have popped up out of nowhere. Stress reduction, sleep optimization, you know, making sure she's got all the sleep hygiene stuff like if her sleep is disrupted, we focus on that first. Yeah. So because if you're not sleeping, nothing else is working. Mm. So, you know, breaking your front like I got a brick. Breaking your phone off of social media at certain hours of the day, getting into therapy if she needs it, like giving her permission to go and do these things and these things actually work. Yeah. And then huge hormones are just a part of the toolkit. They're not, you know, for some women, they feel like they are the thing. But I have to say, for a lot of our patients, they're just one part of a bigger scheme of, you know, how to kind of refocus, reprioritize and make sure you've got everything optimized so that you can live the next 30, 40 years of your life and your best health. Well, it's interesting. One of the things I'm hearing you say is to your point, people will say, oh, maybe I need HRT or oh, maybe I whatever the fix is. But you're when you use the constellation metaphor that really clicks for me because the way I think about it as you're giving the list is essentially we have to learn to take care of ourselves the way we take care of our families. Good sleep, good food, breaks, brain breaks, where you're just entertained, getting outside to play, you know, making sure that certain things about your environment are incredibly conducive to expansion rather than contraction. Things that come naturally to us for our kids, for our partners, for our families. But we usually put ourselves on the back burner. I mean, for me, it was, you know, leaving a job that no longer served me. Can you expand on that? So I was a very successful OBGYN and all the traditional sense of the word. I did the surgeries to live with the babies, you know, did that. And I loved I loved it. If babies came between eight and five every day, I would still do it. Then, you know, everything changed at the hospital, new administration, a lot more administrative burden. They were bringing in multiple levels of administrators above us. The paperwork was getting outrageous. For every hour that I saw patients, I was doing two hours of, you know, pajama work at home, finishing charts and stuff. I mean, that just wasn't tenable. Plus the acuity of the patients, you know, really sick patients, it just was getting in the sleep deprivation from calls. You know, my call was really taking a toll on me. And I had to like have a come to Jesus of how else can I be my best self, you know, and pay my bills and, you know, meet all my family's needs, but not kill myself. I was taking years off of my life, you know, with that job, but it was a job. But I signed up for this, right? Like the guilt and the shame of walking away from this prestigious position at a large academic institution where everyone loved me and I was so popular to go and like field of dreams, like build a menopause clinic. You know, like I didn't know if anybody would come see me. So, but I just like my heart of hearts knew this is not sustainable. And this hospital system does not have another option for me. So I can't keep doing this. And my husband, super supportive, you know, but I just the whole thing, you know, you've built this life and suddenly you can't manage the life anymore. So like giving myself permission to walk away from that was the scariest thing I've ever done professionally, but it is absolutely the best thing I've ever done in my life. That's incredible. Because I am practicing my best medicine right now with my best. Yes. Well, and interestingly, you're you're practicing personally your best life and then your work is your best work. I am. That that's a double permission slip. I would think for anybody listening to this. I am. I'll be 58 soon. I have two grown healthy daughters who are thriving. So like I don't worry about my normal mom worries, but, you know, like they are off on a great path, you know, and I have a 30 year relationship, 33 years, 30 married, you know, with the same person. And we're not going anywhere, you know, we're in this together. And so, but like I'm having a hard time. I have better relationships. We have better sex. I have better, you know, a better work-life balance. I have better everything. And it's like, and I thank menopause for all of it. Wow. And now a word from our sponsors. Okay. So question for our friends at home. You know, I know that you're going to be a good friend. I know there are women listening to us talk who feel dismissed, who felt unheard at the doctor. When they bring concerns, what would you say are the most important ways women can advocate for themselves? You know, do we need to be keeping, let's say, a 30 to 60 day journal of symptoms, gripes, whatever it is to bring in? And in the name Perry menopause, we have a tracker, symptom tracker. And that you can keep track, you know, so that we all tend to forget and get nervous in that little 10 minute visit. So like to prepare, and I have a lot of this on blogs and our website, but you know, big key takeaways, call ahead. Do they do menopause care and pray to God that they're honest, you know, do they prescribe hormone therapy, you know, red flag as if no, I don't believe in it. Well, it's not Santa Claus. So you know, not everyone needs it or just, you know, but you know, is it even something they're willing to discuss? OK, that's not your doctor. You have to be prepared to find someone who will take care of you. So how do you do that? Call ahead and ask, ask your friends menopausesocietymenopause.org has a website. I'm a certified provider on that look for the certified providers. That means we took the test. Go to and not necessarily OBGYN menopause society certifies tons of nurse practitioners, tons of internal medicine, family medicine, like someone who really had an interest in doing endocrinologists, you know, it's not necessarily going to be your OB. On our website, we have thousands of testimonials from my followers and we organize them by city and state. That might be helpful. There's great online options now to companies built actually like MIDI and Alloy to serve, you know, menopausal women seeing this gap and realizing there's an opportunity here. So they built these platforms. Yeah. So like, don't assume your awesome OBGYN who delivers your babies and took great care of you knows enough. They probably they were never taught in residency, I promise. They did not in our CMEs for ACOG, not not anything, you know, significant. And so unless they sought training outside of what's handed to them by OBGYN for the American board, I wouldn't count on them being able to take care of you. They might, but it's not a guarantee. You know, I've seen this and I know we're talking perimenopause and menopause, but I've really seen this also for some younger friends who have been dealing with getting endometriosis diagnoses. My girlfriend, Juliane, has been really public about it. And you know, she's a phenomenal performer and host. And so she's been able to get a lot of attention. I just worked with a great girl on a movie. He was talking to me about it. And just the experience so many women at that stage are going through as well. Years and years to make a diagnosis. Yes. So would you say that some of the things that you have learned to offer women in terms of how to track their journey to discover whether or not they're in perimenopause yet? Would you say that some of that advocacy could also be helpful to them if they may be dealing with trying to get to the end of an endometriosis diagnosis? Absolutely. Endometriosis, fibroids, you know, pretty much any condition that primarily affects women, 80% of autoimmune diseases. You know, women go years and years and years before and how many times were they diagnosed with anxiety or depression or you're just stressed out rather than you have endometrial tissue, which is basically a tumor growing outside of your uterine cavity and attacking, you know, causing inflammation all over your body. It could be anywhere in your body. It's usually in the pelvis. But I mean, I've seen, I've seen in the OR on the diaphragm around the heart capsule. Like it's crazy. It's crazy. It's really crazy. You know, it makes me think a lot about a conversation I recently had with one of our mutual friends, Jeannie Mai. We were together on the podcast when Balance was premiering and you offered such great medical expertise to that docu-series. And one of the things I found really fascinating about that was that the two women who were so central to the story, I'm reminding my friends at home because obviously you know this, you help make it, these incredible monks, these spiritual teachers were really able to track the changes in their personal experiences of their days in their own bodies because their days were so regimented and identical always. And so many of us in this modern era, you know, we've got six jobs and a side hustle and families and travel. It's hard to track well, but you all really helped through telling their stories. I think illuminate this reality for so many people. How was, you know, you took a big gamble leaving your practice and opening your clinic. And then you took a big gamble getting into this world and helping produce a docu-series. How was that experience for you as a doctor because you are a caretaker and you are in ways a detective and then you got to put your detective work essentially into like a mystery movie. Was it fun? So my, in my assisted calls, I'll never forget this. So this was 20, the new menopause has not come out yet, you know. Oh, wow. I had written, yeah. So this was pre, maybe we were about to come out with it, but and hey, there's these two Jane Monks. I didn't even know what a Jane Monk was at the time, you know, who want to do this documentary. They're going to film a documentary about perimenopause. And I was like, whoa, you know, and we set up a zoom call and these two beautiful women with their white robes on their buns, you know, their hair slicked back. But the minute they opened their mouths and they were so sincere and so genuine, they had actually produced a documentary on trafficking. And so that won some awards. So they had experience. And, you know, I was like, this is probably crazy for me to say yes to this, but I feel like we need to do this. Like, and working with them was they brought in the most awesome team. They came to my home. We shot at my house. You know, we spent a whole day together. They came to the clinic. They interviewed a couple of my patients. And it was just incredible. And then, you know, it took years to like edit and produce and multiple, you know, I think it's four parts now. And it is so fantastic. It is telling such an amazing story. And I'm just so proud to be a part of it. Yeah, it's so cool. Oh, I can't believe you got the call before your first book was published. I didn't know that little detail. Well, I had done Galveston diet, but that was, you know, right? A couple of years before that. Yeah, I mean, I guess I guess the first specifically. Yeah, menopause. This, yeah, this, this world. We're going to dive into your next book in our, in our next episode. But before I let you go today, I have to ask you, you've continued to be a trailblazer for women and for yourself, which, as I said earlier, is a great example of signing your own permission slip. Your new book is out in the world tomorrow. I'm curious from this vantage point. I know you've checked so many boxes, but I know I know you as this amazing creative person. I know you're going to have more. So what right now feels like your work in progress? The last 30 years. So, you know, I don't want to call it longevity. I don't like that word. But right now, when McKinsey did the survey and they dug through the research and they figured out that women live 20% of their lives in poorer health, you know, less healthy than their male counterparts. And half of that time is in postmenopause. And we don't age the same. Like men tend to live a more fulfilled life and die quickly. Women tend to have this protracted loss of independence, either through frailty, you know, loss of both. Loss of muscle or dementia and then heart disease as well. That causes them to live this life. And so that happened to my grandmother and my mother. And, you know, both of my grandmother mother had horrible frailty, horrible osteoporosis, multiple fractures and dementia at the end of it. And I remember mom taking care of my grandmother and saying, I won't do this to you. You know, I don't want this for you. And it happened. And I feel like so much of what she's gone through was preventable, but she never got the right advice. She never was taught to focus on the right things. The only thing that woman was told was to be thin. And be thin and you'll be OK. And so she did. She dieted. My mother was on a diet at 80. You know, like, oh, gosh, never lifted a weight. I those memes coming out right now. I'm the first of my bloodline to lift a barbell. That is great. You know, the first of my bloodline to have a professional degree. I'm the first of my bloodline to do a lot, you know, to be able to support myself without a husband. I have a husband, but I absolutely could do it on my own. And, you know, I refuse this. I refuse for this to be the reality for my daughters. Yeah. So the next book, I think, is like is a how do we age well? You know, how do we shorten that time? I want to be a benefactor and not a burden. How do we shorten that time where we lose my independence? My dad, he was telling jokes three days before he died. We all gathered around. It was this beautiful end of life thing. My mom, it's going on for years. You know, like she didn't want this. She didn't deserve this. Yeah. And if and if we can break the cycle in their honor, our daughters get to do it differently. Yeah. Shouldn't we be thriving, not just reducing suffering? And it seems to me that your whole mission is to center not just the betterment of women, but they're thriving. Thriving, right. Because I really feel like this is the time where we could really change the world. Right. Like first we change our family, then we change our community. And then when we're like in our fifties and sixties is when we change the world. Yeah. And so that is, but we're like being hamstrung by menopause or cardiovascular disease or diabetes or aches in pain, you know, whatever, 20% of the workforce in the UK of females quit their jobs due to menopause. When you're supposed to be like leaning in and like the things, the C-sweets. And by the way, when your expertise is at its highest. That, yeah. It's it's a version of brain drain and it sucks. And we're going to put a stop to it. This is an I Heart podcast. Guaranteed human.