Brené Brown: Hi everyone, I’m Brené Brown and this is Unlocking Us. Welcome back to our new eight-part series that I am calling On My Heart and Mind. We started the series with my conversation with Valarie Kaur on the power of revolutionary love and being a sage warrior. I have talked to Dr. Sarah Lewis on her stunning new book, The Unseen Truth, and my friend and Unlocking Us alum, Roxane Gay. And I had a, wow, just a really eye-opening and provocative conversation about her essay on Black gun ownership. Before the series is done, you’ll also hear from me and my sisters on grief, love, and unexpected joy. And this episode is all about the ‘pause, about the menopause.

BB: I’m talking to my friend, also my doctor, one of them, Dr. Mary Claire Haver, who is on the kind of zero bullshit policy with menopause and helping so many of us understand what’s going on, what’s not going on, and how the American medical establishment has a lot of catch-up work to do. Before we jump in, let me tell you a little bit about Mary Claire Haver. Dr. Haver is a board-certified obstetrician and gynecologist. She graduated from LSU Medical Center. She completed her residency at the University of Texas Medical Branch in Galveston. She is a certified medical specialist and Menopause Society certified menopause practitioner. In 2021, she established Mary Claire Wellness, a clinic dedicated to providing comprehensive care for menopausal patients.

BB: In 2023, she published her first book, The Galveston Diet. I discovered her before I saw her, actually. She’s in my neck of the woods, so it made it easier to see her. I discovered her on social media. She has, I think, 4 million followers across platforms. And she’s so good at demystifying information, backing up claims with really solid research. I just am a huge fan. If you do know her, this is a fun conversation. If you have not met her, I’m so excited that you get to meet her. We’re going to talk about her new book, The New Menopause: Navigating Your Path Through Hormonal Change with Purpose, Power, and Facts. And let’s jump in.

BB: Okay. I just have to say for everybody listening, Mary Claire and I just keep looking at each other going, “Are you ready? Are you ready? Are you ready?” I’m so excited. Dr. Mary Claire Haver, thank you for being on Unlocking Us.

Mary Claire Haver: Oh my gosh, thank you so much for having me. I’m… looked forward to this conversation for a month.

BB: I have to tell everybody, I want this claim to fame. I was following you, Mary Claire Haver, before Mary Claire Haver was cool. Just tell them it’s true.

MH: It’s absolutely true. I think I found out you followed me when I had like three followers and I was like, “Oh my god.” That was amazing. So yeah, you’re an OG.

BB: I’m an OG. What are we calling ourselves now? The Menoposse?

MH: The Menoposse. NMP.

BB: The Menoposse, yeah. Yeah, NMP.

MH: The Menoposse.

BB: All right. I’m going to start with, tell us your story. I want to know all about you. I mean, like where were you born? Take us through high school.

MH: Yeah, sure. I was born in Lafayette, Louisiana. I’m one of eight children to the same parents. I grew up in Lafayette, went to high school at a small… Well, big for Lafayette, at the Catholic school system in a Catholic high school. And then one of my little brothers went to college, the rest did not. I enrolled in the local university in my town, which was USL at the time, but they’ve changed the name to ULL, University of Louisiana at Lafayette because we were broke, and I could walk there. And actually got a fabulous education and worked my way through.

MH: So it took me five years, no regrets, and have an undergraduate degree in geology of all things, but no one was majoring in it at the time, and I loved it. I didn’t know I was going to be a scientist when I grew up. I thought I’d be an actress or ballerina, but I had to take a science class and that one sounded cool, and I absolutely was a fish in water. And it was one of those moments where I’m like, “I think I’m smart. Like, is that a thing?” Like I didn’t try in high school. I just kind of showed up, did my thing, graduated the middle of my class, everybody was happy and went to college because that’s kind of what you did. And I didn’t like the options available to me at the time if I didn’t go, right?

BB: Right.

MH: So, but I really kind of found my academic chutzpah when I was in university and took the geology class, fell in love with science. And I took another one and then I took a third one and they’re like, “Hey, we have some scholarship money over here,” and I’m working my way through school. So I was like, “Well, that sounds cool. Let’s see what happens.” And ended up almost a 4.0, did great, got a scholarship to study in New Zealand, went to New… So I’ve worked for an oil company as my little part-time job through college and they basically had a job ready for me. Then I get this scholarship to go study abroad.

MH: So I go do it. And while I’m down there, I have this whole, like, this is not my path. I love this as science, but like, as far as sitting at a desk drilling oil wells for the next 50 years, this is not going to be for me. And the host family that I was down there with were all in medicine. And they’re like, “You should think about doing something medical.” So I wrapped that up, got back to the States, went back to work and told my boss, “I think I’m going to apply to medical school,” and had to take one year of organic chemistry. I didn’t have the right level of OChem.

BB: I was going to ask you if you had OChem because… so you had to take OChem.

MH: I had everything I needed to like apply but OChem. So he’s like… and I said, “Listen, the class is on this day, this time.” And he said, “Make it up on the weekends.” So I would walk in my little outfit with my heels to my class, take my class. The lab was like all Wednesday afternoon. I look like Merlin pouring all these beakers and creating potions and then would walk back to my job. And I applied to med school that year. Like, so I got accepted contingent upon passing organic chemistry, which I did. And so I got to medical school as a geologist. Everyone is nodding along at the first class and I am lost, lost. Like, what are they talking about? I learned none of this in undergrad. And I was like, I, all the loans were so expensive. I’m like, I’m stuck. I have to figure this out. And I did, just tripled down, found some great study partners and finished medical school top of my class.

BB: Wow.

MH: Yeah. And met my husband, Chris, when I was working at the oil company, and he actually helped me fill out my applications and helped me write my personal statement. And so we got married between my junior and senior year of medical school. And we didn’t actually live together full time until I started residency just because logistics and where he was working and medical school and everything. So I tease my children we did it backwards. We didn’t move in together until we’d been married for a year.

[laughter]

BB: It’s a high bar.

MH: So we still survived, we survived. And in medical school, I decided OBGYN. That was my last rotation of my third year and I absolutely fell in love with the drama, fell in love with the babies and all the things, but really grew to love as I practiced, once I got out of training, the gynecology part of it, the one-on-one relationship with my patients. And so I was a academic professor teaching residents, teaching medical students. I was a program director in charge of the curriculum for the residents for over 10 years. So it was when I started going through menopause and my patients were going through it with me. So my patients were aging with me as I was getting older. I was having babies, they were having babies, right? So you kind of age up with your patients in general.

BB: Right.

MH: And I started realizing, I don’t know enough about menopause. I would have told you I was a great menopause provider until I actually was menopausal. And everyone was complaining of weight gain, of, you know, and I was terrified of hormone therapy because of the kind of the fallout from the women’s health initiative. And everything I know now about menopause care is basically self-taught and what I learned through the Menopause Society. So in 2018, I left the university and I became a hospitalist because I really wanted to figure out how am I going to focus on menopause? How am I going to do this? Because in a 15-minute visit with a patient’s feet in stirrups, it’s really not enough time to unpack the menopause trauma.

MH: And, but I was terrified to give up my surgical privileges, we worked so hard for that. So I became a hospitalist so I could go part-time and still operate and do all the things, keep up my skillset and then COVID hit. So being a hospitalist during COVID, I’ve never worked more hours in my life. So grateful to have been part of the solution and doing patient care. And my husband was so frustrated sitting at home, and I got to run away and go to the hospital. But once things calmed down, I decided, “Okay, I’m going to go for it.” And Chris and all my friends were like, “Just try it.” Because I was like, “I don’t know if anybody will come see me as a menopause spec. Like who’s going to come to a menopause doctor? I can’t afford to take insurance because again, 15-minute visits.”

BB: Me.

MH: Yeah. And he said, “Open the doors, see what happens, price it reasonably, and just try. If you feel, you can always go back and go back and do pap smears or whatever you want to do,” which is an honorable thing to do but you know, no, really very few people in the Houston area were doing this. So on a wing and a prayer, I took my girlfriends out to dinner, we kind of walked through how to run a clinic, and I threw up a shingle and it was extremely successful. And now we’ve just hired number four nurse practitioners to help us expand the clinics and was able to write the book and talk about my experiences, and here I am today.

BB: I am so freaking glad that I asked you about your story because I didn’t know your story. Wait, where are you in birth order with these eight folks?

MH: Fifth. So let me expand on that a little bit. So I have four older brothers. They were born within five years.

BB: I was wondering if you were the first girl.

MH: Me, my sister, then my two little brothers. And there’s about a five-year gap between like the boys and then the second family, as my mom always called it. So Jep, the oldest, was diagnosed with acute lymphocytic leukemia when my mom was pregnant with the fourth son. They almost lost him. A Hail Mary drive up to Memphis. He was one of the first patients at St. Jude’s. They were able to get him in remission while my mother was taken across the street for preterm labor. Can you imagine the stress?

BB: No, I cannot.

MH: While we’re living with grandmothers and aunts and we’re all dispersed around our hometown while they’re fighting for my brother’s life. So he goes into remission, he’s doing great, everybody comes home, we go back to normal life. My mom has, so I have my little sister and then my mom gets pregnant. Jep comes out of remission at about 18, 17 and a half, maybe. I’m like seven. Okay. So the whole next three years of my life are keeping him alive. Right? Like, that’s all I remember, is hospital visits and doctors and he’s in remission, he’s out of remission. And so he’s fighting, fighting, fighting. My mom gets pregnant for number seven. And then Jep dies when mom is about six months pregnant for Jeremiah. And then we have Jeremiah and then she a couple of years later has my baby brother, John. But that was a defining moment in our family. Like everything changed after his death.

MH: My parents, I don’t know how they survived it. Very rarely does a couple survive the death of a child. So off we go into real life, college, med school, oil field downturn, my parents go bankrupt. I’m struggling to get through college. I made it, everything’s fine and great life lessons there. Bob, my second brother, was gay. He passed away. So I’ll tell you his story. So I had this one fabulous brother who was so much fun to have as an older brother. He would dress me up, put makeup on me, make me clothes. He had a sewing machine. He was my, one of my best friends and coached me through cheerleading in high school, practiced with me for drama, and then he developed HIV and hepatitis as a lot of men did. And he’d been with the same partner for 35 years. So Bob in 2015, which is part of my menopause story, had been fighting end stage hepatitis basically. And it gets, we get the call that he’s had a stroke and he’s in the hospital.

MH: He’s alive, but his brain’s not functioning that well. And then we get another call that he’s in a coma. So I rushed home and my sister and I, she was a hospice nurse at the time, we did his end of life care and it was a beautiful way to die, with all your family around you. So he also had some behavior choices that he was never able to kick that probably hastened his path to death, and I had to deal with loving him through those choices and accepting that. And I really fell apart after his death. My leave was given at the hospital, I wasn’t able to take much time off because I took so much time to do his end-of-life care. And I was just like, put a Band-Aid on myself and like, go to work. And I would cry all the way home and cry all the way there, like get the emotions out and then patch myself together to take care of him. The meantime, I’m in menopause, and I don’t know it.

BB: Oh, god.

MH: So I had stopped my contraception right before he got really sick at the end. And what I was attributing to grief, definitely there was grief involved. I’m not going to knock the psychological impact of that on me, but I was like hot flashes, body aches, not sleeping. And I’m thinking, oh, I’m just grieving, I’m grieving, I’m grieving. Then when the grief fog started to lift like six months later, I’m still having all these symptoms. And then I’m like, “When was your last period?” Oh my god. Like I didn’t have regular periods ever, so this wasn’t unusual for me. And I was 48, so on the young end, and then I was like, “I think you’re in menopause.” Like, I gaslit myself, I couldn’t even realize, this was my job.

BB: Oh, yeah, no, I know. I know.

MH: That I was menopausal, like fully, and was absolutely miserable and terrified for myself to start HRT. Basically went to the woman who was taking care of me at the time and said, my clinician, and we just had a heart to heart. And I was like, “I can’t live like this. I’ll just take the risk.” And I didn’t realize that the risks had been so overstated and overblown and really had been walked back. I’m still following the 2002 guidelines. And I reluctantly went on HRT, terrified, absolutely life-changing for me.

BB: How?

MH: I got my resilience back. I was flying off the handle at everything. I didn’t realize the hit to my mental health, I didn’t realize the hit to my cognition. I just thought I was getting older. Like I was forgetting the keys, I get in the car, I didn’t know where I was going. I was struggling to like, just common words, I was struggling with patients to explain things that were just so easy to me before. And I really thought, “Am I having early dementia?” My grandmother had horrible dementia. And it, and then when I started HRT, within six weeks, I’m sleeping through the night again, hot flashes have gone away, and I’m just feeling like I’ve got myself back. And at the same time, I’m going through the weight gain.

MH: So I was changing my nutrition, changing my exercise, making so many life changes at that time. You know, looking at my brother and his life choices and how that affected him and realizing we had the same genetics. So my brother right above me, Jude, so right after Bob dies, I get a phone call that Jude’s in the hospital and they see a mass. My sister-in-law was a radiologist technician. So she’s sending me pictures of his scans. And I’ll never forget, I was at a meeting at a restaurant and I was like, “Excuse me.” And I’m picking up the phone and I’m seeing the images come through from my sister-in-law, and it’s giant masses in my brother’s liver.

MH: And I just was like, “I can’t, I can’t do this right now.” Like I am just barely recovering from Bob. And he ended up having metastatic esophageal cancer, stage four, widely metastatic. By the time he was diagnosed and fought that for two years, COVID, in the middle of COVID, we’re sneaking across the border to go help him and go try to see him and spend time with him when all the craziness of COVID was happening. And he’s like, “I don’t care if I die of COVID, please come and see me. I love you. I miss you.” And so we got him through that. I did his end-of-life care, and then my dad died nine months later. And so I don’t know how my mom has done it. Three kids, her husband, she’s 87. She’s not doing well.

MH: It’s just, yeah, been a lot, but part of what motivates me and keeps me going and fighting the kind of people who aren’t pro women having great health into their last 30, 40 years of their life, I’m just saying, I will not stand down. I will fight for the health of women for every decade of her life, especially the last three or four, because now today, Brené, I’m 56, I am healthier, I’m wealthier, I have better relationship, I have better boundaries. What I’ve got with my children now, I want every woman to have, but had I not addressed my menopause and realizing that the way the healthcare system is currently set up is not built to serve a woman after reproduction. Studies aren’t done on females throughout her reproductive life. It’s harder to study females because we have hormonal changes.

MH: And then when hormones walk out the door in menopause, women are just kind of left behind. We forever in medicine, forever in studies have been assumed to be small men with breasts and uteruses. And so we’ll just study the men and we’ll just apply what we’ve learned to females. What’s happened, the end result of that, is that females are living 20% of their lives in poorer health than their male counterparts. We’re much more likely to have dementia and Alzheimer’s. We’re much more likely to lose our independence in old age and require nursing home care. It’s three to one. And so when my patients come in now, that I just focus on these last few decades, we put out the menopause fires the best way we can, HRT, not HRT, nutrition, et cetera.

MH: And then we start, try to help her chart that course for the next 30 years. Because I’m like, “Tell me about your mom. Tell me about your aunts. How’s their health?” And when they’re like, “She’s 95, she’s cooking, she’s cleaning, she’s doing great, she’s playing with…” Great. I’m like, “Let’s do what she’s doing.” But for most women, that’s not the case. There’s a reason it’s A Place for Mom. Okay? There’s a reason there’s a company called A Place for Mom and not for Dad, for Mom is that we are not enjoying the health that we could because I think one of the main things is we’re not addressing menopause and that these studies were never done on females. And that’s my focus and advocacy and trying to get increased funding in the NIH for women’s health after reproduction.

BB: I can see how your fight is fueled by the love of your family and the loss of your brothers. And I’ve put off this conversation with you for as long as I can put it off, like the podcast. I mean, you and I have had plenty of conversations off the record. I’m so pissed off and I’ve got so much, like, if I get through this without crying, I don’t know. I’ve got so much grief from my mom. Like when I started following you, she was already in the throes of dementia.

BB: And I thought about all the things that corroded her life. I mean, the, her frozen shoulder, all of these things that doctor after doctor said were in your head. And the UTIs and the dementia and the don’t get close to HRT, to any kind of hormone therapy. And my mom just fricking as the survivor that she is, just slugging it out until you can’t win, until she’s just dying. And she doesn’t know who we are, except maybe in flashes. And what do you make of the collective grief and rage? Do you see it, or is it just me?

MH: No, it’s not just you, because I talk to women every day, and it is the rare patient who is not watching their mother not live a healthful life who is plagued with something for decades. No one expects to get out of this alive. We all know something’s going to take us out one day.

BB: Right. Yeah.

MH: But the collective experience of females and the way we were trained to address female complaints is we’re taking something biological and assigning a psychological cause. And we are basically small emotional men. There’s a reason why hysterical is a word and we don’t have testerical. And that has got to stop, that has got to stop. Now, light at the end of the tunnel here. My daughter is in medical school. She’s a second year. She is well aware, her classmates are well aware, and they are not going to put up with this.

MH: They’re going to believe their female patients. And just automatically, when you come up blank as a clinician, not to automatically assume, it’s all in her head. So I think there’s hope for the future. We are slowly, slowly, slowly getting more and more research funding dollars into health after reproduction for females, drops in the bucket so far but there is awareness and I think we’re going to get there. I think it’s going to take a generation. Things in medicine don’t move quickly, but I think there is hope in the future.

BB: I have a story that’s similar to yours in some ways because Steve was in residency when we got married. We did not live together. I was in graduate school. We commuted to see each other. And we got married in that one week the residents have off between third and fourth year. And we went to San Francisco because we had to go somewhere really close. And there were six other residents there on honeymoons from different residency programs. So I speak that language.

BB: When I got pregnant, I was in my PhD program and I had really, really significant hyperemesis. And the things that stand out for me about getting pregnant in the PhD program is that that at the time there was a male head of the PhD program who looked at me when I told him I was pregnant and said, “We really thought you are going to be someone, we really thought you were going to have a career.”

BB: And I was like, Jesus, it’s a pregnancy, not a lobotomy. And then of course I get very, very sick and I have to take a leave of absence because my multi-linear statistics professor would not let me throw up in the trash can during class. And then when I had hyperemesis, I had a female doctor and I picked her because she kind of looked like a hippie and I thought this will be good for me. And she said, “I’m wondering… What we know about hyperemesis is… Yeah, are you worried about attention from people shifting from you to the baby? And is this a psychological reaction that you’re having?”

MH: So I was taught the same thing. I was taught that there’s a significant percentage of hyperemesis, now, this was in the ’90s, that is psychological. We were putting people on antipsychotics for hyperemesis. That has been completely debunked. We have found the receptor in the brain that is causing this. And I have to shout out to Shannon Clark, right in Galveston, who presented to the FDA, she’s done the most research on this.

MH: And bravo for, it’s unbelievable to me, who had hyperemesis with number two, who would, stuck on I-10 in traffic, would open the truck door and throw up outside, or throw up at like, take off my lab coat and throw up in the lab coat and just put it on the side while I was in the car on the way to go deliver a baby. And this was before Zofran became widespread used and all these new medications that actually treat the root cause of hyperemesis. But yeah, 15% of women who are pregnant have significant hyperemesis. And we were trained that the majority of those, it is attention seeking or something psychological, and she can’t help it, but it really is a psychological cause.

BB: I mean, could you imagine like I am, I’ve lost 18 pounds, I’m having to get IV fluids, I can’t keep down anything, and then I’m told that it’s in my head. And then I start to think, “Oh my god, am I going to be a shit mom? Like, what’s happening?” And I leave my OBGYN for, because Steve’s a pediatrician and I go to one of his friends who I didn’t want to go to because he’s kinda like a good looking guy that I know outside of the hospital. And I’m like, “Oh god, okay.” And he’s like, “What do you mean in your head?” And I, and he’s like, “This is not in your head.” He’s like, “Let me show you some blood levels. Let me show you what’s going on in your body. I bet you’ve never had a miscarriage.” And I said, “I haven’t.”

BB: And he said, “Yeah, your progesterone levels are through the roof. It would make an NFL player throw up all day and night. You have these massive protective factors going on, you’ve got probably some gene stuff going on.” My mom had hyperemesis, and he said, “And you might be better in 18 weeks and you may not.” And so at 18 weeks I started swimming a mile a day until, including the day I gave birth. I was in good shape, I was lucky that way. But I thought that could have upended me almost permanently to be told like this thing that I really wanted and that we were trying to have happen, that I was attention seeking. Like, what the actual, the hell?

MH: So one of the most popular treatments for hot flashes that is being touted as, this is the route we should go, especially in Europe, is cognitive behavioral therapy. Which I love, for a multitude of things.

BB: I mean, I love too, but shut up and sit down.

MH: As a psychologist, cognitive behavioral therapy, if you just outthink your hot flash, if you change your perception of your menopause, it’s…

[laughter]

BB: Yeah. Okay.

MH: This is today. We have got to stop automatically attributing, I can’t tell you how many, I read these research papers all day and when I get to the inevitable, “But this is a tough time for women, this is a difficult time. Her children are leaving. Her… ” I’m like, you never, I know you know the psychological research better than anybody, but I don’t see that when I read research studies for men. I don’t read a lot but it, you never see, “It’s a tough time in his life,” when you look at erectile dysfunction, “He’s really stressed out at work,” and all these things. And it’s automatically in so many of these articles, so ingrained.

MH: When we look at female sexual function, okay, loss of libido, this is, and when we look at it in a woman who’s got no pain, she can orgasm, we’ve ruled out the anatomic causes, has a great relationship with her partner, used to have a good libido, and now it’s gone and it’s distressing her. She misses it and she wants it back. When I tell you that is 25% of my patient population, I was taught nothing about that in medical school or residency. And the answers coming out of clinicians’ mouths, who I think are well-meaning, are, “Have some wine. Go on date night.” Instead of, “This is biological, and we have FDA approved medications and testosterone options for these patients.”

MH: But so many of the older research is it’s psychological, she doesn’t love her husband. And she’s sitting here telling me, “I have a great relationship with this person. I’ve been with them for X amount of time. This used to be amazing for us, and now it’s gone for me.” And it’s distressing me and it just kills me that I’m automatically assuming there’s something wrong with her here and that it’s psychological or attention seeking instead of, this is a biological neurotransmitter change and it is affecting that part of her brain. And we have ways that we can fix it.

BB: I follow you voraciously on social media.

MH: Bless your heart.

BB: You’re really brave. And you and I share the experience of kind of being shot out of a cannon into that space. That’s a brutal, unhinged, dysregulated space.

MH: Yes.

BB: How has that been for you?

MH: I got some great advice from actually Shannon Clark, who kind of blew up in the OBGYN space on social media before I did. And she was kind of my guide through the early days and she said, “If something doesn’t feel right or you’re going to do something you feel like might be controversial, sit on it for 24 hours and then go back and look at it, take the emotion out of it and then go back and look at it.” So that has been great for me.

BB: That’s great advice.

MH: The menopause space is exploding, and I’ve been shot out of a cannon into it. So we have people who are downplaying the female experience, so there’s…

BB: For sure.

MH: There’s several things that are coming at me. One, that I’m causing women because we’re educating them as to what might happen so they’re prepared and have a plan, that it’s actually making the experience worse for females, that we don’t want to educate them because now they’re going to fixate on these things and think that they have them. Okay? These are PhD people saying this to me, that we best not, don’t educate.

BB: Don’t educate them. Yeah.

MH: Yeah. So the don’t educate thems. The people who are seeing a financial opportunity, good or bad. Now, I have financially benefited from this, full disclosure, through my clinics, through Galveston Diet and that whole world, but that are creating plans or supplements and promising miracle cures.

BB: Real nutty shit. Yeah.

MH: So there’s that. And there’s people who just don’t want other people speaking in the menopause space. Early voices in the menopause space who are feeling kind of left out and left behind. And so what I love about The Menoposse is it’s a group of thought leaders, clinicians, we have multiple specialists from across the board. Cardiologists, psychiatrists, reproductive endocrinologists, sexual medicine specialists, orthopedic surgeons for the frozen shoulder part of it and the musculoskeletal syndrome of menopause who are saying, “Quiet the noise.” We’re bonding together. Do we agree a hundred percent on everything? No, because we’re humans, but we are all here realizing there’s a problem. We have bigger platforms, we’re going to educate, we’re going to elevate each other. So you always see me talking about…

BB: I love that.

MH: Other people’s books.

BB: True. All the time.

MH: Sharing other people’s videos because I don’t want to hold the megaphone for the rest of my life. I feel like this message, we are so much stronger together and the more brain power together. And so I have 28 clinicians coming to Galveston in January for The New Menopause Conference, and it sold out in two and a half days, 800 seats. We’re going to have a live stream digital option, it’s going to be insane, but it is thought leaders, Tamsen Fadal, who did the menopause documentary.

MH: We have cardiologists, we have Avrum Bluming, we have oncologists, really to just set the record straight so that, and it’s not for doctors, it is for, lots are coming, but it is for lay people as a way to educate and bring in all the voices and let them ask their questions so that we can elevate this and women realize they’re not stuck. You can thrive at this age and so many women are not. And they’re being denied good education and the opportunity to live their best lives for the last third of their lives.

BB: There’s so many things that I profoundly respect about you and your work. One of them is, I love how you are constantly bringing up peer reviewed articles, you’re democratizing the information in them, you’re helping us understand it. And I’ve seen moments where you’ve also come on and said, “Hey, I’ve said this in the past. Here’s a new study. It’s changed my thinking. I was wrong. The new data convinces me that we need to think about this differently. Here’s what I’ve learned and here’s what the new data say.” I have so much respect. And then I’ve seen you not back down around reproductive rights.

MH: Nope. I, just last night from the comment about execution after birth, that’s not a thing, that doesn’t happen. And as an obstetrician who has sat at the bedside of thousands of women in the most joyous, the most horrible, the most gut-wrenching, the most mundane, the most, I cannot… every emotion, every possible scenario at the bedside through the birth of children and to accuse obstetricians of execution of newborns is ridiculous.

MH: So I reposted something from a friend who’s a reproductive endocrinologist, and of course my DMs were full this morning of, “I love you, I love what you say, but don’t get political because I’m going to have to unfollow you.” And I’m like, “I will not stand down. I will not. Unfollow me. I don’t care.” No obstetrician is executing newborn children. That kind of rhetoric is so insulting and harmful, not only to every woman who’s given birth in every situation, but to the healthcare providers who are out there doing their absolute best.

BB: I know.

MH: Sometimes with impossible laws and situations. So, sorry, I got so emotional and my AirPod fell out.

BB: It’s worth it.

MH: Abortion care is healthcare. It always has been, it always will be. It’s not for everyone. I respect your decision, but until you have been in the situation and stood at the bedside of someone making impossible choices and the fallouts from that, you really don’t have a voice in this discussion.

BB: Amen. Let me, before I get off this, not just reproductive rights and abortion care is healthcare, which I just, and don’t even understand the complexity of that actually, I’ve been surprised on your social media to see… I want to understand it. This is not an indictment. It’s, I’m really curious. Help me understand, what do you make of the pushback against some of your work from male trainers? That has been very surprising to me.

MH: Yeah. Not all, there’s some amazing…

BB: I’ll tell you right. First of all, not all, because I have a male trainer who’s my age who thought he was introducing me to your work. And I’m like, no, I’m part of the original MCH gang. So not all male trainers, mine’s amazing.

MH: No.

BB: But I have been surprised by, I don’t even know how to stereotype, younger, I don’t know who they are. What’s happening?

MH: Listen, they take these courses to become trainers and some are accredited, some are not. But they are taught calories in, calories out is the way. I was taught that in medical school.

BB: But still? But they’re still taught that?

MH: Not now. We now know that a person’s weight health is multifactorial. Okay. It is not just calories in, calories out, it is biopsychosocial. And these trainers have been taught, this is it, this is the system, this is the way, calories in, calories out. Women for decades, me included, I had thin privilege, thin was healthy, Brené. And as long as I was thin, I was good to go. Little did I know that constant caloric restriction and cardio was eating away at my bone and muscle strength for the critical years of my life. And that I should have been lifting heavy because I’m a naturally low muscle person and that muscle is what is going to protect me from diabetes.

MH: So these trainers, calories in, calories out, it’s your fault because you are lazy or you are just not trying hard enough. And here I am sitting at the bedside or sitting in the clinic and these women are swearing on a stack of bibles that they are calorically restricting, they’re doing all the things. And the latest research in women through the menopause transition is with no changes in diet and exercise, you go from… so visceral fat, you have a body composition change, undeniable science, meaning where and how you deposit fat changes. I don’t have to tell menopausal women this, she knows. Okay.

BB: No, yeah, you don’t even have to, yeah, I got you. I got you.

MH: But the math…

BB: I get it. I see it. Yeah.

MH: You have, of your total body fat, 7% is visceral, which is intraabdominal. That is the dangerous fat. I’m not talking about your curves. God gave you that. Okay? Postmenopausal through the transition goes up to 23% on average, 23% with no… she did nothing different. Her insulin resistance increases as well as her NLDL drops and her LDL goes up. So her cardiovascular disease risks increase. There are these sweet, well-meaning trainers, most of them, who have built a billion-dollar industry on shame, on shaming women, that they’re not trying hard enough, they’re not doing enough and creating these programs. And the women are on little hamster wheels trying, trying, trying, trying, trying, trying, trying and the trainers are coming back and saying it has to work.

MH: So now with modern science, with GLP-1s, with HRT, with understanding female physiology and what she’s going through, I’m not saying workout isn’t important, it is, calories are important, but it’s much more complex than that. I do see trainers now starting to embrace this, and I’m trying to elevate their platforms and their voices, who are understanding it is more than that. But when I see this egregious, absolute shaming and people coming out and saying, “Your menopause is not a thing, your menopause is not causing your weight gain.” I don’t stand for it. And those are the funnest videos I’ve ever made in my life. And so, because I come out…

BB: They are good to watch.

MH: With article after article after research article, and I just pop them up. And then I show pictures of visceral fat and I talk about cardiovascular disease risk, and has nothing to do with your weight or your BMI. Well, very little, not as much as your abdominal circumference and the amount of visceral fat. Not to say that how much you weigh is not important. And so getting women to let go of this number on the scale as a measure of their health and their risk of chronic disease and their risk of going into a nursing home is so freeing. And so now in clinic we talk about eating more, not less, eating more protein, eating more fiber, eating more fruits and vegetables, eating more plants instead of, “Oh, watch this count, can’t eat that. Oh…” you know.

MH: And for myself, my patients, our staff, it’s just a better, it’s so freeing mentally. So yeah, I’ll keep coming after them. They’re getting quieter, but it’s threatening their industry. And instead of embracing the woman on the GLP-1 and like, how can I change the program to serve her better so that she ends up healthier, a woman on HRT or the combination, the ones who are doing that successfully, the women are flocking to them and they’re having much better outcomes with their programs.

BB: I can feel the tide shifting. I mean, I think when, a couple things, when you’ve got my trainer who’s my age saying, “You need to read about this menopause,” and you know, “Mary Haver’s really doing some good work over there and she’s down the street,” and then you’ve got Peter Attia, who’s kind of a bros bro, saying that what we’ve done to women is the biggest medical ball drop in the last 100 years.

MH: Yeah.

BB: And then I saw someone on your page that I thought was really interesting, where it was a young trainer, super fit, what you’d expect, saying, “Just imagine if when guys turn 50, their balls start shrinking and this happens, and this happens, we’d have a billion dollars worth of products and research,” and you know, and then, up pops your head. “Now, listen to what he’s saying,” and I’m like, and I didn’t know it was a stitch from you, but then when your head popped up, I was like, of course. And look at her amplifying the voices of people who are saying, “I care enough about my coaching clients and training clients to unlearn, relearn, and own some stuff.” That’s powerful, right? And I think you are responsible for a lot of that, you and your Menoposse. Really I do.

MH: We’re trying and we’re trying to walk the walk as well. Like you see like Rocio Salas-Whalen, like so many of us are showing we’re actually out here lifting weights and trying to eat, put more plants on our plate and make sure we’re getting adequate protein and you know, really trying to show what we are doing to kind of set a course away from what society has built for us, which is long-term loss of independence in our older ages. And decreasing the risk of that starts right now, not waiting ‘til we break.

BB: What are you excited about? What are you excited about? Now, this conference in January, you told me it’s already sold out, but we’ll put a link to it on the episode page. But tell me what you’re excited about in your own advocacy, in the world of medicine, what’s exciting for you?

MH: So at the conference we have about, according to like the director of the women’s health research at UTMB in Galveston, there’s about 50 medical students who want to present on menopause, you know?

BB: Shut up.

MH: Everything from metabolic… So my daughter’s working on the metabolic syndrome of menopause, her friends are doing some of the orthopedic data and they realize they have a pretty high chance of getting published, which is kind of a big deal right now. They are like going all in on this. So that kind of thing, I’m super excited about this next generation. Like, they don’t put up with anything. My kids hold me accountable for everything that comes out of my mouth, especially in social media.

MH: Seeing that enthusiasm, seeing Gen X rise up and say, “I’m not going to accept this, there’s a better world for me out there, I want this to be better for the next generation.” Like, they’re not just so into themselves, they really want better health choices for their daughters, their nieces, the younger females in their lives, that excites me. Every time I see Jennifer Weiss-Wolf or all of the legislative stuff that’s happening behind the scenes and it’s really bipartisan to improve our health, let’s uncouple reproductive rights for one minute.

BB: Yeah.

MH: Because everything in women’s health kind of gets skewed towards reproductive healthcare, which is important, a hundred percent important. But I’d like to have a conversation about the gender health gap and that, you know, the research, the studies not being done in women. You know, let’s look at statins, Brené, and I don’t, I’m not telling anyone to throw their statins out the window, but there is no data to suggest that a statin in a woman will decrease her primary risk of a heart attack. It is not preventative for women, it is for men. Baby aspirin, never been shown to be preventative of a heart attack for women, only for men. But yet we’re routinely recommending this stuff all the time.

MH: ACE inhibitors, never been shown to be effective for women, only for men, for primary prevention of a heart attack. The cardiologists are not happy about this. They’re working on solutions, but yet today we’re still routinely recommending statins for every woman with high cholesterol. You know what actually decreases your primary risk of a heart attack? Is HRT, starting young, within the first 10 years of your menopause. So that’s the kind of thing more women are becoming aware, they’re not putting up with it. They’re demanding more research and studies so that their health can equal that of a man’s, and we not be in the lower 20%.

BB: How many crippled-up mothers are we going to have to bury before people start saying, “What is happening?” I was in the conversation the other day with a bunch of my girlfriends, and we are in our mid to late 50s. And they were talking about the stress on their dad as caregivers, and how all of their fathers have become caregivers for their mothers and how that’s changed so much. And I was like, “Yes, that’s hard. Can we talk about why our mothers can’t get out of bed?”

BB: Why my mom had to get a chair and set her blow dryer on her sink because she couldn’t move her arm, why our mothers all have cognitive decline. I agree this is hard as hell on our dads, but can we talk about why we’re burying our unrecognizable mothers? And two of the people at the table, I mentioned this because two of the people at the table who are girlfriends of mine are physicians. And this stuff is indoctrinated.

MH: It’s indoctrinated and pat her on the knee… When you look at the statistics of women being misdiagnosed, 50% more likely for a heart attack. You know, even the language we use in medicine, atypical chest pain is how a woman presents with a heart attack. That’s how women present. We’re 51% of the population. Why are we calling this atypical? Men have the jaw pain, the shooting stuff down the arm. Women have fatigue. Women’s present very differently than males. This is built into the system, and it’s going to take a lot of unpacking, a lot of dismantling.

MH: I don’t think that the health of women after reproduction should be dumped on the lap of the poor busy OBGYN. This should be mandatory for every clinician who’s going to touch a female, that they understand the gender-based biological differences on how humans age. And it should be completely separated. This is why mama is not doing well in old ages, having protracted loss of independence and requiring long-term care and why it’s dumped on daddy’s lap. And if dad dies first, guess who takes care of it? The eldest daughter.

BB: Oh yeah. Yeah. I think it’s really the unlearning. I wonder sometimes, this is my contribution from my field of study, I wonder if the unlearning, even for healthcare professionals, is, people are so resistant to it because of the copious amounts of grief and rage that come with it. There is so much grief attached to the notion that we have no value outside of our ability to have children.

BB: And anything that happens to us mentally, physically, emotionally, spiritually, cognitively after that is not really relevant or important. I mean, I remember a friend of mine who was a physician saying, she thought her mom’s dementia came from years of resentment of caregiving. And I thought, “Maybe that’s a factor.” I mean, I’m a multifactorial girl living in a one-factor world, but I also thought that’s not too far of a stretch from me being told that puking 18 times a day was in my head.

MH: It was in your head.

BB: Yeah.

MH: So here’s where I feel like the tide has shifted and where I’m seeing the most powerful stories are coming making people wake up, is the gerontologist, the people who are doing end of life care, the people who are taking care of the elderly and the disabled and the, you know, women are ending up in nursing homes for two reasons in general. One, loss of cognition, two, loss of physical function. And the loss of physical function is because of low muscle mass or chronic fractures from osteoporosis, which is preventable.

MH: And so these clinicians are out there screaming on social media, “This does not have to happen.” So these are other voices I’m trying to amplify. I’m not trying to create panic or, you know, that’s the other thing I get accused of, is “You are just saying these horrible things to get likes and clicks on social media.” I’m like, “I am sounding the alarm because this is the path that society is happy for us to head down and I’m not signing up for this.” I deserve…

BB: I mean, you’re not… Like that’s so funny that that would be an accusation. It’s like seeing a roaring blaze that’s killing and hurting people and then pulling the alarm and then being asked why you started the fire.

MH: Yeah. The people out there who are taking care of, you know, Vonda Wright, who’s an orthopedic surgeon…

BB: Oh, love.

MH: Does so much work with osteoporosis and talks about bones like butter and these poor women and this was avoidable and all the fallout and the pain. You know, 50% of women will have an osteoporotic fracture before they die. 25% of men, hello, you fall and break a hip, 79% of women without surgery will die in the first year. And it is not a good year. It’s a horrible, horrible, horrible, horrible year. Even with surgical repair we’ll lose 29% of those women in that first year. This is the alarm we’re sounding. This does not have to happen. We can take steps to prevent this. And these are the messages we get, you know, “Calm down, calm down. You’re scaring people.” I’m like, “Yeah, because we as clinicians are scared.” We don’t think this has to happen.

BB: Well, I’m going to end here. I am so incredibly grateful for your work. I’ve read both of your books, The Galveston Diet and The New Menopause. And I will tell you the funny thing about The Galveston Diet, I am very anti-diet culture, very reluctant to pull up a book that has the word diet in it…

MH: The word diet.

BB: But I loved you, so I read it. I completely changed the way I was eating. I don’t think I’ve been hungry a day since I read it. I cuss you when I’m getting to about 80 grams of protein a day, and like a, no pun intended, shit ton of fiber. But like I am, it’s so funny, I’m so strong all of a sudden, like when I’m lifting my carry-on over the overhead bin, I’m like one-handed being like, ho, ho.

MH: I love it. I love it.

BB: Yeah. Yeah. And then The New Menopause…

MH: 18 weeks on the bestseller list. I mean, you have been like my, “What would Brené do?” So, you have just been such a great coach to me through this whole process of creating and publishing. And thank you so much for your encouragement and kind of big sister virtual hugs through the drama of it all, but we are now at, today, the list comes out, you live and die by this list. At my level and we’re at 18 weeks so far. For this type of book, this is in a category that is dominated by males, I’m like, “Let’s go ladies. We got this.”

BB: Let’s go folks, LFG. I mean, and the book is so empowering. It gives us data, it honors our own self-determinant decisions about what we do with that data. I’ve never once heard you say that one solution is good for everyone. I’ve never seen you afraid to back off something where you’ve changed your mind, which to me, I think it’s Adam Grant that says it’s great to have knowledge, but real wisdom is the ability to unlearn and relearn and talk about that. You’ve really made a difference in my life. And I think about my own daughter who knows more about menopause at 25 because I’m talking to her about it. I will not ever let her believe that she’s crazy. I just won’t ever let that happen. And so here’s to the girls that we’re raising.

MH: Cheers. That’s it.

BB: Cheers. And you’ve made life better for them and for me. And I am really, really grateful for that. And I know what it means to take a stand on issues, but I can’t believe if anyone knows you, they’re ever surprised about anything you say because you’re so rock solid in what you’re doing and what you believe. So, I’m super grateful.

MH: Well, thank you. I’m… but right back at you. Your work has been incredible and a cornerstone in my life. So, so appreciative.

BB: Yeah. Here’s to raising strong women and helping the ones that you know, and I’m not going to say that I don’t say “F you Mary Claire Haver” when I’m trying to farmer carry my weight, or 50% of it, but I have definitely gotten meaner and stronger and I’m going to credit you with both of those.

[laughter]

MH: Yeah. Strong over skinny. Strong over skinny. Come on ladies.

BB: Thank you Mary Claire. Really appreciate it.

MH: You’re so welcome.

[music]

BB: Okay. I told y’all she was good. She is a force of nature, and I love that she’s a continuous learner, and she does not stand down on women’s health, even when it gets really hard. And you can learn more about this episode along with all the show notes on brenebrown.com. We’ll link to Mary Claire’s book, The New Menopause. We’ll have transcripts for you within three to five days of the episode going live. Thanks for listening, I really appreciate it. Stay awkward, brav,e and kind, and I’ll see you soon.

[music]

BB: Unlocking Us is produced by Brené Brown Education and Research Group. The music is by Carrie Rodriguez and Gina Chavez. Get new episodes as soon as they’re published by following Unlocking Us on your favorite podcast app. We are part of the Vox Media Podcast Network. Discover more award-winning shows at podcasts.voxmedia.com.

 

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