The Daria Hamrah Podcast
Do you want to change or simply improve your life? Take your business or your personal relationships to the next level? Have you ever thought why change is so difficult? Ever wondered how people become successful and we just call them "lucky". The Daria Hamrah Podcast gives you Dr. Hamrah's personal insights and pathways to his successes and what he calls "true happiness". Featuring interviews with some of the most successful entrepreneurs, authors and experts in their field, he shares their insights into what he calls the "Secret of Life".
The Daria Hamrah Podcast
Your Body Is Not Betraying You: Understanding the Science of Menopause - with Dr. Mary Claire Haver
Menopause represents a profound transition that affects every woman, yet remains shockingly misunderstood by the medical establishment. Dr. Mary Claire Haver, board-certified OBGYN, certified menopause specialist, and bestselling author of "The New Menopause," joins us to expose the striking gaps in menopause education and treatment that leave millions suffering unnecessarily.
The conversation quickly moves beyond hot flashes to reveal how menopause impacts virtually every body system. "I knew more about the bottom of the ocean than about menopause," Dr. Haver confesses, despite years of medical training. She explains how falling estrogen levels affect brain function (70% of women experience cognitive changes), cardiovascular health (2-3x increased risk of metabolic syndrome), bone density (greatest acceleration of bone loss occurs during perimenopause), and mental health (40% increase in disorders during transition).
Most surprisingly, Dr. Haver reveals how a single flawed study from 2002 dramatically altered women's health for decades, creating widespread fear about hormone replacement therapy despite subsequent research showing its benefits far outweigh risks for most women. "For the vast majority of patients, especially starting early, the benefits will far outweigh the risks. She'll live longer, have less cardiovascular disease, less osteoporosis, less dementia."
Beyond medical interventions, Dr. Haver offers practical strategies for navigating menopause: prioritizing protein intake and strength training to preserve muscle mass ("the most geroprotective thing in the woman is the muscle"), consuming diverse plant foods for gut health, and addressing stress. She emphasizes that understanding menopause's comprehensive impact is essential not only for women's health but for relationships, noting that many divorces trace back to unrecognized and untreated menopause symptoms.
Whether you're approaching menopause, supporting a partner through it, or seeking to better understand women's health beyond reproductive years, this episode offers invaluable insights that could transform your perspective on this universal female experience. Share it with someone who needs this information—chances are, that's almost everyone.
Dr. Mary Claire Haver
Website: https://maryclairewellness.com
The Pause Life: https://thepauselife.com
Instagram: @drmaryclaire
Book Link: The New Menopause
Tweet me @realdrhamrah
IG @drhamrah
All right, everyone, welcome back to the show. I'm Dr Daria Hamrah, your host, and today's conversation is going to change the way you think about aging, health and the most overlooked transition in women's lives, which is I'm sure you all guessed menopause. My guest is none other than Dr Mary Claire Haver. Menopause my guest is none other than Dr Mary Claire Haver I'm sure you've heard of her through social media and she's been on many podcasts recently in the past year who is a board certified OBGYN and certified menopause provider and best-selling author of her book that she published last year the New Menopause. This is more than a medical discussion today, so it's a wake-up call, a re-education and a movement to empower every woman to step into this next phase of life with strength, with clarity and science on her side, whether you're a woman going through it or a spouse trying to understand it, or a practitioner seeking to treat it better. You need to hear this.
Dr. Mary Claire Haver:So let's dive into the conversation on menopause, one that's really long overdue. So I want to start this by a quote, with a quote by Mark Twain, who says the two most important days in our life are the day you're born and the day you find your why. So, Mary Claire, what is your why? Why did you take time out of your busy practice in life to write this book called the New Menopause? And why did you call it the New Menopause? Is there an old menopause?
Dr. Daria Hamrah:So my why is realizing that I spent four years in medical school, four years in residency and probably 18 years in clinical practice and I knew more about the bottom of the ocean than I did about menopause and health and women and that just became my why and my passion, because sadly it took for me going through my own menopause transition and just absolutely I thought I'd be one of the lucky ones who would have this whisper of inconvenience. I thought.
Dr. Daria Hamrah:I'd be one of the lucky ones who would have this whisper of inconvenience, but it was a storm that completely took me out and I just thought if I'm sitting here suffering, what are all the other women doing? I can't be alone in this. And I realized that so many patients were trying to tell me, but I didn't know how to listen. I didn't know how to connect the dots between every organ system that was affected by the change in hormones in the female body. Just, we were never taught that.
Dr. Mary Claire Haver:Is it something that happened suddenly? Or did it creep up on you and you just didn't understand how to interpret the symptoms and put two and two together? I mean, you talk about the storm, but did you see clouds on the horizon and wondering where they're coming from and when they're going to get here? Because obviously you are a board certified OBGYN and you knew, and then even knew, one or two things about women's health.
Dr. Daria Hamrah:So now that I look back, there were clouds on the horizon, but I didn't know how to recognize them. I rewarded myself by being the busiest person I knew. Right, I was a mother, raising children, working as an OB-GYN you know all of us who take on these incredible roles in our lives and there was no time for me to have downtime. But something was changing. Another thing was I was on birth control pills to control polycystic ovarian syndrome. So I realize now that most of probably the overt symptoms were masked by the fact that I was taking hormones for a different reason and I got off the pill at about 48 to see where I was hormonally, and that's when the symptoms hit me like a train. I wonder if I hadn't had that kind of abrupt transition. You know, if I would have been so motivated to, you know, get to the bottom of this had it been less dramatic for me.
Dr. Mary Claire Haver:But my point is the symptoms that you're describing. How are they same for everyone, or did they? They're different. So can you walk us through the symptoms, first of all your personal symptoms, if you want to share them, and then the most common symptoms that are overlooked not just by the patient but also by the primary cares and the ob-gyns, by the medical system, because that is very important for women listening in my training I was taught that menopause was hot flashes.
Dr. Daria Hamrah:About 85 of women would have hot flashes and most of us are taught that. We all know that it is a hallmark and it's interesting because that is a symptom that's hard to blame on something else.
Dr. Mary Claire Haver:Sure.
Dr. Daria Hamrah:Right. So most of us know cycle menstrual irregularities, hot flashes, generally urinary syndrome, but only like later, like older menopausal ladies will have dry vaginas and stuff. I never was taught that that could start in perimenopause and we knew that down the road osteoporosis might be a factor as well. And that was it. I had no idea that menopause affected the brain, affected sleep, affected our liver in the form of changing our cholesterol numbers, affected our insulin resistance, affected our musculoskeletal system. The greatest acceleration of bone loss and muscle loss is in perimenopause and I didn't realize that menopause was the turning point for the dramatically increasing risk of cardiometabolic disease. And so, just you know, taking a woman through the menopause transition increases the risk of metabolic syndrome. Two to three X, you know, if you age match them increases the risk of metabolic syndrome.
Dr. Mary Claire Haver:Two to three x, you know, if you age match them, and and so how is the general medical community responding to these symptoms? Um, and compared to from 20 years ago, I know there was a study relating hormone replacement therapy, for example, to breast cancer, and that obviously omitted a lot of women from getting proper care when it came to replacement therapy. How is today different? Because there is not, I would say, one or two patients a month, or even a week that come to me that have the symptoms. When I ask them if they have discussed hormone replacement therapy with their patients, either the answer is no or they say my doctor doesn't recommend it because of the risks, and this is 2025.
Dr. Daria Hamrah:Yeah, so I have a daughter in medical school. I was a residency program director until 2018. So there's a little bit of a gap between when she started school, what I know they're being taught now versus what we were teaching up until 2018. And it was that hormone replacement therapy for most patients, the risk would outweigh the benefit, and that theory is based on the very outdated study.
Dr. Daria Hamrah:One study that did not reach statistical significance in 2002 changed the course of women's health outside of reproduction for decades and when you think about that, you know there have been multiple looks back at the study. The data has been walked back. For the vast majority of patients, especially starting early, the benefits will far outweigh the risks. Her quality of life will improve. She'll live longer, she'll have less cardiovascular disease, less osteoporosis, less dementia, and most docs have not gotten the message Now. This is not the fault of the individual clinician. This is the fault of the system. Women's health has been overlooked and undervalued outside of reproduction. When you look at time and training, nih funding, all of the critical, you know ways that we measure what matters in health and how we're going to teach our you know, educate our clinicians. Women's health outside of the breast and uterus is almost non-existent. You know, like, how we disease differently, how we have cardiovascular disease, how our bones deteriorate quicker, how we have increasing rates of dementia, those are just classically understudied.
Dr. Mary Claire Haver:So wasn't that study debunked, though 10 years later? And I mean we're talking about at this point 10 years Multiple?
Dr. Daria Hamrah:things have come back and walked back, but it went viral before there was viral right. It was the number one medical news story of 2002. It was on the cover of every paper. It was on NBC Nightly.
Dr. Mary Claire Haver:News. I remember it was on Good Morning America.
Dr. Daria Hamrah:I remember I was the chief resident the year it broke and we were terrified and all we heard was estrogen causes breast cancer. That's not even what it said, right, it was the estrogen and progestogen arm, which is a synthetic progester which none of us use anymore, you know, had a non-statistically significant increased risk and it was a. It was a, you know it was. It was a relative risk, not an absolute risk. The absolute risk was minimal and so therefore, women 80% of women threw their prescriptions in the trash. They were absolutely terrified. Everyone bought into this notion that somehow the natural hormone our bodies make is somehow trying to kill you. Where in pregnancy, when we have the highest levels of estradiol floating around our bodies, breast cancer is almost non-existent. You know it happens, but it's extremely rare and the most likely time we're going to get breast cancer is when we have no estradiol in our systems. You know it. Just when you think about it logically, it really doesn't make sense.
Dr. Mary Claire Haver:So where do you think the medical system has failed? In that that they didn't make the debunking of those old studies viral enough so that it would penetrate the medical system Right? So guidelines.
Dr. Daria Hamrah:You you know it takes 17 years to change a guideline. You know that right, yes.
Dr. Daria Hamrah:And so the guidelines, like the American College of OB-GYN guidelines today it is 2025, say the lowest dose for the shortest time possible. That is based on nothing. There's no clinical evidence to support that. The Menopause Society guidelines say it's completely different. Benefits outweigh the risks. Keep her on it as long. As for her, the benefits outweigh the risks. There's no age at which you must need to stop right. It will always protect your bones and it's FDA approved for the prevention of osteoporosis. So our guidelines are not agreeing across different medical specialties. There needs to be. No one is in charge. There are no adults in the room when it comes to women's health after reproduction ends.
Dr. Mary Claire Haver:So once we're done.
Dr. Daria Hamrah:Having babies no one's in charge.
Dr. Mary Claire Haver:Well, the fact that there is a menopause society and then there is the OBGYN society, that in reality they should be one, they should be one society. I mean, menopause is, as far as I remember from basic biology, is part of women's health, so but I mean think about it.
Dr. Daria Hamrah:Should the poor, busy ob-gyn, who's a part surgeon part, you know we're wearing so many hats really be in charge of the whole shebang?
Dr. Mary Claire Haver:no I agree, so yeah so I agree in subspecialization, but to the the very least they should be aware of that. They should agree on one type of treatment. They should know the symptoms and they shouldn't poo-poo or minimize the symptoms and the necessary treatment for menopause, so they can at least channel the patient appropriately and answer their questions. So at least they should have the same message. They shouldn't necessarily treat them, at least they should have the same message. Not they shouldn't necessarily treat them, but they should have the same message. And that is the thing that is bizarre, like why has medicine gone so siloed that two specialties or subspecialty and a specialty can communicate? And we see that throughout medicine. This is not just for OBGYN menopause, this is for all specialties and subspecialty.
Dr. Mary Claire Haver:There is this tribalism going on, almost this false sense of pride where you know. Sometimes I ask myself, why are we even in this field? We're in this field to serve patients, not to. I don't know, to be honest. I don't know the reason. But here's the good news, mary Claire. I think people like you, or the internet, social media, they have raised patients' awareness where they are now able to look things up themselves so that they can ask the proper questions. And if they don't get the proper answers. They can then make a decision. They have a choice to go seek a different opinion. I think this is the era of empowerment. I think social media, even AI, significantly have empowered the patient. And the other downside is the distrust in doctors now. I mean that isn't on the rise. I mean we can't deny it Right.
Dr. Daria Hamrah:That is undeniable and it is a shame because most doctors are amazing and wonderful human beings and the lack of knowledge and education around menopause is not that doctor's fault. They're doing their best with what they were taught. They're overscheduled, overworked. You know. I never want to say you know they're, of course they're bad apples. They're in every, every, every walk of life. But I think you know they're, of course they're bad apples. They're in every, every, every walk of life. But I think you know most people went into this to help people and they're really trying to do their best job. And and what's happening in medicine as far as the corporatization and the administrative burden put on the physicians, you know, to see more patients in a shorter amount of time, I mean, menopause is complicated, it's hard, it mirrors so many other diseases.
Dr. Daria Hamrah:How can you do that in 10 minutes with your feet in stirrups?
Dr. Mary Claire Haver:I mean you're being very kind by saying that. You put it in a very kind way. I'll be a little more direct because I feel as physicians because we're dealing with people's lives we have a bigger responsibility. It's a more of a calling than blaming the system, I feel I kind of don't agree with that because it's you're basically leaving the door open for anyone with an excuse to walk through. You're basically leaving the door open for anyone with an excuse to walk through, and I think we have a greater responsibility. To the very least. Don't tell the patient that hormone replacement therapy is bad and they're going to get cancer, like that's where I would draw the line, that's a problem you can't.
Dr. Mary Claire Haver:There's no excuse for that. I agree with you when you say well, they're overwhelmed.
Dr. Daria Hamrah:They can say well, I'm not an expert in it, but I can refer you to someone, to a menopause specialist.
Dr. Mary Claire Haver:You don't have to practice menopause care, yes, but to scare the patients and do fear mongering. I mean, that is complete misguiding and that's where I draw the line and for me there is no excuse and based on the science, today it's borderline malpractice. Because let me ask you a question, maybe you can answer that how many relationships? If you give me a percentage, now we know I think it's something like 70% of.
Dr. Daria Hamrah:Marriages they end up in a divorce. I read that somewhere, I think.
Dr. Mary Claire Haver:I think 70% are initiated by women. It's it's a right over 50 that in the war, okay, so so. So do you think Menopause has anything to do with it?
Dr. Daria Hamrah:Absolutely and not in all cases, of course, but I I have two or three, four good friend patients who are divorce attorneys and they love to talk about this. So they gave me all their opinion on everything, because they are in it every day and they say two things happen. One, she circles the wagons around herself and says this was not a relationship that was serving me. I've got 30 more years to live and I'm not going to live it with this guy. Okay, there's something about menopause that gives you the power and permission to put yourself first. So that's like some of the divorces, but others are. She is going through a massive transition and overhaul and, and her whole life, the way she looks at things, the way she's reacting, we see a tremendous loss of intimacy.
Dr. Daria Hamrah:You know at least 50% of my patients are suffering from decreased libido, meaning they miss it. They had it. They had a healthy sex life that they loved and they they miss it. It's not there anymore and they love their partner and you know it's not a relationship issue that can destroy marriage. You know they're they're emotional. 40% of women have an increase in mental health disorders, you know. So across the menopause transition and so all of these things. You know she is changing, he is not, and that's going to create a disconnect in a relationship and that might be part of the divorces as well. So the divorce attorneys are like if we treated general urinary syndrome of menopause, if we treated mental health disorders in perimenopause, if we, if these weren't a thing, if this was like nipped in the bud and we get all these people, you know, taking care of, how many divorces would we avoid? And they think a lot.
Dr. Mary Claire Haver:I know I mean geez, I don't know if they've done a study on that, but it's hard to do a prospective study but at least like a retrospective study where I had just had a patient last week, literally. I took her medical history and I saw she's on hormone replacement therapy. I'm like so, it always impresses me. I'm like, okay, I asked him who's your doctor and how did you find out? How long have you been on it, et cetera. And she looked me in the eyes and with tears in her eyes, she said it saved my life, it saved my marriage. And then she looks over to her husband and they both start hugging each other and I'm sitting there. I'm like, okay, do you want me to leave you guys alone? I can come right back. But the the?
Dr. Mary Claire Haver:That's when I realized how important this is for relationships. You know, not just for, for, for a woman of, as a self-empowerment or health tool, but relationships. And that's why I asked you that question, because until I saw that couple it wasn't on my radar. I didn't even think in those terms. I was just thinking in health terms. Now, if you're a woman listening to this, what can you tell them as far as symptoms to look out for and before you maybe say that, can you describe perimenopause, you know the process of perimenopause, how it leads to menopause, post-menopause, so that women that are listening, in all groups of ages, can understand where they are, and then they can correlate those symptoms.
Dr. Daria Hamrah:So menopause is when we run out of eggs. So human females are born with our entire egg supply. We have about one to 2 million at birth and then by the time then we go through a process called atresia, which is survival of the fittest. The healthiest eggs live and then the weaker egg. The weaker eggs kind of die off at a very quick rate. So by the time we're 30, we're down to about 10% of our egg supply, and by the time we're 40, we're down to about 3% of the original egg supply.
Dr. Daria Hamrah:And menopause represents the end of eggs, ovulation and the production of our sex hormones, which is basically estrogen, progesterone and testosterone. Now we have other sources of testosterone, so I'm going to leave that out of the conversation for now, but estrogen and progesterone. Um, ovulation begins in the brain. So we have a gland in our brain called the hypothalamus. You and I know what it is and it is always looking for estrogen. There's a little wire just pretend that goes into the blood and is like where's the estrogen? So when estrogen levels start dropping off after ovulation, it says Whoa, I want more estrogen. So it starts sending signals to the ovary. It's basically something called GnRH talks to our pituitary gland Pituitary makes LH and FSH. Those go and bind to the cells around the eggs to create estrogen and then progesterone after ovulation. So we have this beautiful EKG like ebb and flow of our monthly cycles in a healthy woman who is pre-menopausal. Okay, month after month. You know, on day 12, you're going to do this day 18. You're going to do that Now if you have, if you have hypothyroidism or PCOS. This is not you, right? But this is a woman who has a normal monthly cycle.
Dr. Daria Hamrah:Here comes perimenopause. The brain detects low estrogen, the signals go to the ovary but we don't have enough eggs to respond like we used to. So the brain is like, hey, I should have gotten my estrogen by now, I don't see. It Starts pumping more and more hormones from the brain to the ovary so that FSH and LH gets higher and higher and higher. Boom, we get the ovulation. We get these surges in estradiol, much higher than we ever did in our normal menstrual cycle. So what used to look like an EKG now becomes very chaotic. We have delayed estrogen. Very erratic, sporadic ebbs and flows, and progesterone never kind of catches up to where it used to be. So I call it the zone of chaos and it becomes more and more chaotic until the whole thing it's like a jalopy and just until you're out of eggs and that is full menopause. That chaotic zone can last seven to 10 years. So before your cycles ever become irregular, the brain knows something is wrong.
Dr. Daria Hamrah:So in perimenopause, quite often the first signs and symptoms that we see begin in the brain sleep disruption, mental health changes, cognitive changes in brain. Fog Periods are still regular, but the brain is working harder and harder, which is affecting our levels of neurotransmitters. Okay, serotonin, dopamine, norepinephrine all of them start becoming a little bit more erratic. So we don't. The brain doesn't function as well. All of them start becoming a little bit more erratic. So we don't. The brain doesn't function as well. So 70% of us will complain of cognitive changes, 40% increase in mental health disorders across the transition. Now those are the people coming in complaining and getting a diagnosis. Imagine how many people never said anything and just kind of dealt with it.
Dr. Daria Hamrah:So perimenopause, actually the first symptoms we see are in the brain. All of a sudden, you're not sleeping as well as deeply, you're waking up in the middle of the night, you're struggling to go to bed, more nighttime, anxiety, restless legs we're just seeing you know before your periods ever become irregular. Now here comes the joint pain, here comes your elevated cholesterol. Actually, a beautiful study just came out of I think it's China, somewhere in Asia. A beautiful study just came out of I think it's China, somewhere in Asia, where they're looking at small dense LDL particles as a marker of perimenopause, because we don't have a good blood test for perimenopause. But it looks like tracking this one particular LDL particle is going to be really good because it doesn't increase with age, only with menopause.
Dr. Mary Claire Haver:Is that why women post-menopause are at higher cardiovascular risk?
Dr. Daria Hamrah:Yes, so across the menopause transition, like I said, 2 to 3X syndrome. So we lose the elasticity in our endothelium, so we have increased blood pressure.
Dr. Daria Hamrah:So, yeah, the arteries, so our arteries, become stiffer, so we have elevated blood pressure, we have much higher levels of insulin resistance in prediabetes and of course then diabetes, and all of that leads to, and of course our LDL goes up, our HDL tends to decline, ldl goes up higher than HDL drops, but all those three together is the trifecta that leads to increasing risk. And there's something, this anti-inflammatory property of estrogen, that decreases the rate of plaque deposition that you see in a pre-menopausal woman. She's protected against that accelerated plaque deposition where she loses that when she becomes post-menopausal. So we do lag behind men for about 10 years in the risk of cardiovascular disease once we go through menopause, but then we pass them up.
Dr. Mary Claire Haver:Interesting, and that's the reason why our endothelial cells have estrogen receptors right.
Dr. Daria Hamrah:Yes, and that's what we think.
Dr. Mary Claire Haver:Interesting. So at what point, then, in the perimenopause, should a woman adjust her hormones with actual HRT?
Dr. Daria Hamrah:Well, this is all expert consensus, because there's not been a single large study done on the treatment of perimenopause. Nothing, we have nothing.
Dr. Daria Hamrah:That's shocking, so it is a bunch of experts who get together and like my friends on our group chat on WhatsApp, the menopause and like how would you treat this? What if she comes in with this? We're like, okay, early perimenopause, she's still cycling regularly, she's having mental health. You know it really have to look at it symptom by symptom. But really the sooner, the better we know for mental health, the sooner we support the estrogen, the better we know for sleep, for and especially for cognition and risk of long-term dementia. The earlier you treat, the better, including early perimenopause and for cardiovascular disease risk.
Dr. Mary Claire Haver:And then let's say you haven't gotten the early treatment and what is the current consensus in initiating HRT treatment?
Dr. Daria Hamrah:So it depends on what you're trying to prevent, right? Hrt is not FDA approved for prevention of anything.
Dr. Mary Claire Haver:True.
Dr. Daria Hamrah:Sorry, except for osteoporosis. But the U? S preventative task force has not. You know, again, they're not all agreeing right and the task force so, like people who are in the old menopause, are saying well, the U? S PTF is not recommending it, so we can't recommend it. Yet the FDA has approved it for prevention of osteoporosis, for prevention of osteoporosis. So you know what I'm just gonna do.
Dr. Daria Hamrah:What's right for the patient and if she wants to prevent osteoporosis I'm going to talk to her about this is the most effective way to do it, you know, is hormone replacement is not be menopausal and we have an artificial way to do that with hormone replacement therapy. If she wants to prevent cardiovascular disease, that's different. Estrogen is better at prevention than cure, so you need to get it on board before she develops those calcified plaques. So the only way you know that in an older patient with risk factors is to get a calcium cardiac score and then use that number to help guide your treatment options. So I can't promise her cardiovascular protection after the age of 60. Now maybe if she doesn't have existing cardiovascular disease, we may be able to get her a few years, but starting the younger the better.
Dr. Mary Claire Haver:So let's say, 10 years after menopause. You see your 10 years post menopause and they say you know, these studies show that ideally this works if you do it within the first 10 years, correct, Right? Does a woman get any benefits if they do HRT after that time?
Dr. Daria Hamrah:Yeah, certainly if she is having, if she's still symptomatic as far as based on motor symptoms, yes, she will have benefit. No doubt no one's arguing with that. There was a great study that came out looked at Medicare beneficiaries who were continued on HRT after the age of 65. Okay, so women who kept going after 65 had lower all cause mortality. They lived longer, they had less cardiovascular disease and less dementia. That is something worth paying attention to.
Dr. Daria Hamrah:Hot flashes are the bell ringer of stroke, cardiovascular disease and diabetes. If she's still into her 60s and having hot flashes, I can't promise we're going to prevent those diseases. But you know you want to prevent her hot flashes.
Dr. Mary Claire Haver:Interesting Because she's not sleeping Right. Well, I mean, I think anyone listening to this either knows someone or is someone that has these symptoms in menopause or postmenopause, mean it's uh, it baffles me why we don't have enough studies when it's the most common it's a hundred percent of it. It's the most common. Yeah, right, so, and we don't have enough studies. What is? Is it because it's not um, doesn't have enough incentive for pharmaceutical industry?
Dr. Daria Hamrah:is it because, like, that's, that is a problem, right? So the nih they had a billion dollar grant. It was the biggest study in women's health ever was the whi. We were so happy and so excited that women were finally being studied, and then the whole thing got cocked up, right? So then that scared the NIH off of anything clinically reasonable in hormone therapy, right, like not even a discussion.
Dr. Daria Hamrah:So then you have big pharma. All they're working on are CERMs, selective estrogen reuptake modulators, so so things that are, you know, kind of look like estrogen but work a little bit differently, and we need those. There are patients who can't take estradiol or shouldn't because of risks, and so CERMs come in really handy for them, but they're not, you know. And then there's VOs that just treats them. A regulatory center in the brain, that's it. It doesn't treat your bones, your muscles or anything else. It's not the root cause. So but as plain oral estradiol is $2, nobody makes money off of that, it is $2. So no one cares. It's's like when you look at the economics of it hrt is cheap so but it's easy.
Dr. Mary Claire Haver:Therefore, it's easy to conduct a study, right, I mean?
Dr. Daria Hamrah:you would think. But to get that thing approved is really hard, and you know I don't want to get into politics but getting anything approved is really hard. But you know I don't want to get into politics but getting anything approved is really hard. But you know, stepping outside of the NIH, there are still studies going on. Lisa Moscone has just been a huge grant it is from a pharmaceutical like foundation to look at what is the connection between menopause and Alzheimer's disease, and she's not having to publish, you know she. They're not forcing her to publish papers every five minutes. She just basically is focused on outcomes and she thinks she could do it in three years. So there is some innovation going on with how we're doing studies, um, by you know, and so I'm I'm really positive about that, and there's still tons of studies going on outside of the U? S. So don't give up hope, you know.
Dr. Mary Claire Haver:Yeah, no, it's, it's just, uh, it's sad there's many fields in in medicine that don't get funding. They're so crucial because of that issue that we're talking about and you would hope, at least you know, there would be, you know, private funding, or at least academic institutions.
Dr. Daria Hamrah:They would support that just for the sake of medicine and advancing health, and it's just, you know this country is about to have the biggest wealth transfer in the history of the world from men to women, as this generation dies off and money goes to their wives. And these women don't buy rockets and they don't buy jets and yachts. They invest, and they invest in research and philanthropy. So we're hopeful that we'll be seeing more yes this kind of research coming out.
Dr. Mary Claire Haver:Yes, so what do you? You know, let's talk about some practical stuff for women. Listening to this, what are some of the things that women can do? By the way, can you, if you don't get hormone replacement therapy, can you do anything through lifestyle changes to improve? The symptoms and the progression. Can you kind of give us some practical advice, and you're so good about it on your social media. But I just want for our audience, our listeners, if you can kind of guide them with very simple, practical things that are doable and sustainable long-term.
Dr. Daria Hamrah:So when I, you know my patients leave clinic with a toolkit, I'm not just giving them estrogen and progesterone, it's not just a hormone clinic. I don't do that Right. They get a whole lifestyle recommendation. I have a body scanner where I'm measuring visceral fat and muscle mass, and we're having deep conversations around longevity and I call it nursing home prevention.
Dr. Mary Claire Haver:You, know, women live longer than men like by five years.
Dr. Daria Hamrah:So no woman I know wants to live to 120. She just doesn't want to be in a nursing home. That is our goal. So I'm like, okay, I got you on that one Weightlifting, you know what. Muscle preservation and building muscle. The most geroprotective thing in the woman is the muscle and the ovary, and we lose our ovaries. So those are the two things. So how do we do that? Make sure you're getting adequate protein, so many?
Dr. Mary Claire Haver:women are not getting enough protein in their diets to sustain muscle mass.
Dr. Daria Hamrah:So I didn't, I didn't. I was focused on weight loss my entire adult life. Like, stay small, stay small, stay small.
Dr. Mary Claire Haver:And it's so beautiful now that I'm getting bigger and if you go to the gym you see a spinning class or some aerobic class, it's filled with women and you go into the weightlifting departments only men and there's getting better?
Dr. Daria Hamrah:I think so. I, you know, like my generation. They hear the call. Everyone's buying weighted vests, they're joining gyms, they're hiring trainers. They're you know, they're hearing the message that this muscle is going to protect me from the last 10 years of my life being plagued with chronic disease and frailty. They don't want that. They're getting it. Adequate protein, adequate fiber. Most women in the US are only getting 10 grams of fiber per day. We need 35 to 45. Fruits vegetables.
Dr. Daria Hamrah:Fruits and vegetables, whole grains, seeds, legumes, nuts, you know, like plants and protein. That's what I tell my patients, especially on GLP-1s. I am like plants and protein are your goal. Don't look at anything like. That is what your foundation should be your protein, and then fill the rest of the plate with plants. We have a 30 plant a week challenge. Can you get 30 different plants in your diet per?
Dr. Mary Claire Haver:week. I don't even know if I know 30 plants. I gotta look at that. Um top of my head I could come up with 12, but jeez, I gotta look at that so movement stress reduction, you know like well, that's easier said than done.
Dr. Daria Hamrah:Oh my god, your cortisol levels are high. You're a woman yeah, like how are we gonna bring them down? You know I'm like oh, your cortisol levels are high. You're a woman Like how are we going to bring them down? You know, I'm like don't watch the news.
Dr. Mary Claire Haver:Don't watch the news.
Dr. Daria Hamrah:Get off your phone but like take that time to like sit in silence, meditate, journal, pray. You know what is it going to take to bring you back inside of yourself. Do a gratitude To me. Gratitude journaling changed my life. To sit down and write all the good things in my life every morning, how do you?
Dr. Mary Claire Haver:motivate patients. I do that personally and I always talk to patients about it. I realize as soon as I tell them that their eyes start going to the sides, they think, like this is like woo-woo stuff. How is that going to help me? It's easy for him to say how do you get them to actually buy into it? They have to help me. It's easy for him to say yeah, he's, you know, it's it's. How do you get them to actually buy into it?
Dr. Daria Hamrah:they have to buy into it. I talked about the time I hit rock bottom and they and like I was desperate, I like had to do something because I was gonna can you?
Dr. Mary Claire Haver:can you talk us?
Dr. Daria Hamrah:uh, talk to us a little bit about that I was in the pause and I had two teenage daughters and my older daughter. I just felt like I lost her, like I lost any, any real connection with her. And this is my daughter in medical school now. You know, like, like, on the surface it just looked like everything's fine, she's going to go to med school, she's a straight A student, she looks like me. But I just felt like I didn't even know her anymore and I wanted that back and I had to stop blaming her for that and look into what I could do. So I got therapy and I always thought it was woo woo.
Dr. Mary Claire Haver:Did you used to blame her oh?
Dr. Daria Hamrah:totally, Totally Blamed her. She doesn't understand, she doesn't appreciate but like but. Then I thought back to my relationship with my mother, which is not a place. I saw she and I heading towards where I am with my mom and I didn't want that and I realized I had to change. She was the kid and that this was me as an adult and my responsibility and I was risking that relationship with her for the rest of my life. And it was hard and it was over two years and and it's never going to be perfect. But, like me, working on me changed everything, everything in my life.
Dr. Mary Claire Haver:And they call my relationships better. How did you do that?
Dr. Daria Hamrah:I got therapy. I worked through some of my trauma. I, you know, went through cognitive behavioral therapy. I learned how to self-regulate. My daughter was asked to go into her own therapy, which she did, and I, you know, writing checks left and right for whatever she wanted and it it's so much better and it's made everything better and it just really made me appreciate how all of us have something right. All of us have have trauma but like we've got to come back to ourselves and, you know, I love myself now and I'm doing good in the world. And one of the most powerful things when I feel like that, you know I get dragged on social media or have a you know colleague. You know want to take me down for something. What do I know is true? Want to take me down for something. What do I know is true? What do I know is true?
Dr. Mary Claire Haver:You.
Dr. Daria Hamrah:I am a good person, my intentions are, are pure, my you know, maybe sometimes I don't say the right things, but you know, taking it back to yourself and taking that time to write down what is good about me and you know forever. I was always so self-critical you're not working hard enough, you're not this enough, you're not that enough. And I really think menopause has given me the permission, that gift to give myself, you know, because if I didn't, I wasn't going to make it wow, what a powerful story and how long did it take.
Dr. Mary Claire Haver:How how long was that process? And how's your relationship with your daughter now? Do you guys ever talk about those times? It's funny. Does she know what you went through?
Dr. Daria Hamrah:I mean, she's in the grind, she does.
Dr. Mary Claire Haver:Because that would be very valuable for her if she hits that point at some point in her life. You know, remembering how it was with her mom.
Dr. Daria Hamrah:She's studying for step one in the other room, so you know she is in the grind right now. I hope she's studying for step one in the other room.
Dr. Mary Claire Haver:So you know she is in. I hope she's listening secretly.
Dr. Daria Hamrah:She's like we were with some elderly grandparents who were really struggling and I was I was trying to juggle, you know, cleaning and you know, all trying to act like everything's normal, when we got two really, really sick grandparents and she kind of caught me in the corner like heavy breathing, and I was like I'm trying to self-regulate. She said I see you, mom, I see you, it's okay, you know, and I really felt like that was a connection, you know, like I was like okay, okay, okay.
Dr. Mary Claire Haver:And so, out of when you share these stories with your patients and you try to motivate them to, basically you're, you're trying to make them buy into the treatment, the stuff that they can do, and it's always hard to sell someone a treatment regimen that involves, um, the patient put in, putting in a lot of time and effort themselves, as opposed to just a pill. Right, I mean that, mean that is a hard sell.
Dr. Daria Hamrah:So what I frame is the outcome, and the outcome is not looking good in a bikini or whatever. It is avoiding the diseases that are plaguing her elders. And if she's taking care of an older parent or aunt or grandmother, or watch the disease and suffering. She's motivated. I just have to point it out. And then they're. They're like, okay, I'll do anything not to be like that, not to burden my children, not to have the decisions I'm having to make for people who can't take care of themselves anymore.
Dr. Mary Claire Haver:You know, I don't want to live like that, that's a great most motivating thing doesn't it require a lot of self-awareness from the patient standpoint though? I mean, don't you have patients that they always blame the outside for whatever misery they're in and don't necessarily buy into an outcome that involves them putting a lot of work in? How many percent of your patients would you say? I want to know your experience, and I'm being a little cynic on purpose. I want to play devil's advocate here.
Dr. Daria Hamrah:Most of my patients follow me on social media, so they've been on a journey with me, right? Because?
Dr. Mary Claire Haver:it takes a long time to get into seeing and they follow and they watch and they've read the book.
Dr. Daria Hamrah:So I'm so lucky that. I'm not meeting strangers, I don't know them, but they're coming in and they know everything about me and what I've said and what I've read. So that's a little bit unique in my practice, because they are already bought in and they just want to know the numbers.
Dr. Mary Claire Haver:Okay, let's talk about the time where you didn't have a social media platform. By the way, when did you start this approach? When did you get into menopause? I did you. When did you start this approach? When did you get into menopause? I know you said like what, 2018? Was it?
Dr. Daria Hamrah:2018 was when I launched. I started kind of like playing around on social media and women's health.
Dr. Daria Hamrah:In like 2015 is when my brother died and when I started working on nutrition end of the program, and so I was kind of mark everything by then. So it's been about 10 years that I've been doing this. Now I was growing kind of steadily. And then COVID I really blew up on TikTok, so that was like the first way where I hit 2 million like within a year. And then Instagram kind of took over and when reels launched, and so now we're at about 2.7 million on Instagram. So I have over 6 million across like the big four YouTube, Facebook, Instagram, six and a half million. So that's been a few bursts, but fairly, you know, it's been tracking for about 10 years.
Dr. Mary Claire Haver:So it so obviously it's easier for you to have your patients buy into your trip, because they're already listening to your content. They're already, so to speak, primeded. How was it before that, though? Um yeah, so when I first opened the clinic.
Dr. Daria Hamrah:Yeah, so you know it takes me an hour to see the patient and I've stepped outside of the third party model and so I just have a one-on-one relationship without an insurance company telling me what I can and can't do. And I have no, I am the boss, which is the funnest thing ever, and so, and if I need to take more than an hour, I do, but like, I schedule a good solid hour of face-to-face time with the patient, so we have time to kind of work through and I have extensive paperwork they do ahead of time, so I know their family history, their medical history.
Dr. Daria Hamrah:I know what their chief things are when they get there and we can really just start drilling down and and helping her kind of craft what she wants, what are her goals and how are we going to meet those?
Dr. Mary Claire Haver:And so how did you? Because that's very interesting, for we have a huge audience of physicians listening to my podcast and I'm sure there are many I know personally know them. They're contemplating the transition from going away from the third party model, that party model like you have, which can be a little scary which is scary because you know it's not very predictable.
Dr. Mary Claire Haver:You're not gonna, you don't know how your business is going to or whether or not your business got. So how did you obtain the courage to do that and how was it in the initial stages for you?
Dr. Daria Hamrah:so I had always been employed. I had just walked into an employee contract for every job I've ever had I've had three, you know and I just showed up with my stethoscope and my laptop or my iphone, you know, and went to clock in, clock out, clock in, clock out of.
Dr. Daria Hamrah:Clock in, clock out? Of course we never clock out, true, always doing stuff. So, you know, I knew I had good rapport with patients. I knew, like, once I got them in the door, like that would be fine, I took my girlfriends out to dinner like six of them and said, okay, I'm dreaming of opening this clinic. Would you come? Like, would this be something you would come? We're not going to take insurance. And would you come Like, would this be something you would come, we're not going to take insurance. And like it was overwhelmingly yes. Like, if you don't do this, you have to do this.
Dr. Mary Claire Haver:Like this is your passion, this is what you're doing, so I got buy-in from my like six mom friends, right, I did not know how to open a practice.
Dr. Daria Hamrah:I like had to go buy a guide like the idiots. And I had a few friends in concierge medicine. I didn't want the exact like monthly payment concierge model, but I talked to a ton of people, a ton I interviewed with a couple of concierge practices didn't feel like the right fit and I think I really just want to do this on my own. So my CEO at the time COO, was like here I'll help you build it. She was my office manager, but when you, I didn't need a nurse because I'm not doing physical exams. I didn't need seven people in the back office running insurance forms. We were just collecting money up front. I mean, I went through the state guidelines to make sure we did all the things.
Dr. Daria Hamrah:And I threw up a shingle and started advertising on Google and for local patients and so, and talked about a little bit on social media and I had a pretty big email list at the time so we just, kind of, on a wing and a prayer, figured out what it would take for us to break even what would we want in profitability, how many patients would that take and figured it out, you know. And so did we make mistakes? Yes, would I do it a little bit differently? Yes, but now we have, you know, we've bought our own building. I rented for three years. We bought our own building. I have another physician and three nurse practitioners and we have a waiting list of over a thousand. So it was profitable. So if anybody out there is listening and you want to do a no third party model, however, you want to decide what you want to charge, so that's reasonable practice you can do it. Women need this care. They are desperate for this care.
Dr. Daria Hamrah:I now have patients flying from all over the US to come and see me because they can't find anyone near them who can do it.
Dr. Mary Claire Haver:I know. That's why, before this podcast, I asked you, because I have a lot of women asking me and I have trouble sending them somewhere.
Dr. Daria Hamrah:Yeah, Like you shouldn't fly it. You have to fly it. I mean I'm honored, but I mean my God really I know, yeah, I know For menopause.
Dr. Daria Hamrah:So the Menopause Society has a list of certified providers on their website. That's a place to start. They're not all perfect, but, you know, call ahead. We have have a resource of recommended physicians on our website, recommended by my followers. So we have several hundred that they've written testimonials for, and we've organized them by city and state and country. And then, um, there are great telemedicine platforms out there that are built specifically to take care of menopausal women. I will leave off the ones I don't love, so I'm going to talk about MIDI health, alloy health and ever now, ever now. Uh, vetted all three. Looked at their treatment protocols. They're legit, um, and very, very reasonably priced. Midi takes insurance, so they do use the insurance model if that's the route you want to go. The other two are very, very reasonable. So there are options out there if you can't find any one local are those links on your website for me, yeah, so we have on our website something called the menopause empowerment I'll put.
Dr. Daria Hamrah:I'll put the link for the audience on the 14 pages long and it's like questions to ask your doctor, lab test to ask for how to find a physician. It has tons of links, basic nutritional recommendations, the fiber, the calcium, the vitamin d all the stuff that I would recommend in menopause that's all there and it's free.
Dr. Mary Claire Haver:So where do you see the signs of menopause and women's health going into the next decade? I'm sure you're at the forefront of this, so you're probably the best person to ask this.
Dr. Daria Hamrah:So I feel like. So I get reports from my daughter, so she's just finished second year.
Dr. Mary Claire Haver:Is she going to do OBGYN?
Dr. Daria Hamrah:She says absolutely not. Oh, okay, I think she'd love to do women's health. She just doesn't want to suffer through obstetrics, right? And so I don't know if she likes psychiatry or internal medicine. We'll see. She hasn't done her wards yet, so we'll see what she does.
Dr. Mary Claire Haver:Well, at least she went into medicine. None of my kids are interested in going it's like okay and going it's like okay. Well, my other baby's doing pr and marketing, so nice, that's exciting.
Dr. Daria Hamrah:the other direction.
Dr. Mary Claire Haver:That's um yes so the next decade I feel like it in.
Dr. Daria Hamrah:It's probably a decade away from a woman being able to confidently walk into her clinician's office and expect to have a reasonable conversation. You know we just are going to have a big train and lagging in education.
Dr. Mary Claire Haver:Even with social media and AI. You think it's going to take a decade. That is so depressing.
Dr. Daria Hamrah:To like get up to speed and reading and understand. I mean, you know, my book is written for lay people, not clinicians. The Menopause Society they only certify twice a year so it takes about six months. So like, who has that time when we're all busy clinicians, you know. But if you have a special interest and you want to carve out the time, you have to go outside of your training to be able to do it.
Dr. Mary Claire Haver:So you think just the access to people like you is going to be the limiting factor, not the information?
Dr. Daria Hamrah:Right For right for now, yeah, just find someone who's comfortable are you serious?
Dr. Mary Claire Haver:yeah that is the most depressing news I've heard. I don't know there's.
Dr. Daria Hamrah:You know the telemedicine platforms are growing. We have we're have stopgaps, you know, to get us through. But we're gonna have to retrain our practicing clinicians or give them. It's gonna take months. You know it's not. It's not a weekend course you go take in your menopause certified. It's hard what does? Every organ system in our body you know, some days I'm a psychiatrist or an internist or an auto, you know or rheumatologist so what about these concierge practices, these primary care medicine physicians that have concierge practices?
Dr. Mary Claire Haver:they, they spend a lot of time with their patient. I mean, I feel that should be their purpose in a way, because they have already the business model, so knowledge can't be an excuse for them.
Dr. Daria Hamrah:Did they get the training? Did they go outside? You know, depending on what they learned in their residency, they most likely have not received adequate clinical training to take care of menopause oh my gosh.
Dr. Mary Claire Haver:Well, um, that is not very good news. I did not expect that yeah, um so where do you see the role in in men in this? How can men support? The women, um their wives, their spouses, um have you, you know, thought about that and do you involve men of the spouses?
Dr. Daria Hamrah:I tell you my my best visits with patients are when their partners come in.
Dr. Daria Hamrah:So, um, and because the partners are usually venture into a gynecologist office, or they are because they care. You know, no one wants to be in my office with me to be there, and so they are coming from such a place of they love this person, they want to understand this person, they understand that this person's been hijacked by this hormonal shit, by this natural transition, and they want to understand so that they can be more supportive. So the, you know, the best podcasts are going to be this one. You know, when I'm interviewed by men, it's a really different vibe than when I'm interviewed by women, because you're coming at it from a place of understanding versus someone who needs to share their story, and there's nothing wrong with that. But I feel, like my you know armchair expert, steven god, I've done so many with with just guys um, that those are better for guys because they're asking the dude questions, you know, and it really helps get your mind wrapped around what she's going through and you know the reason.
Dr. Mary Claire Haver:And the reason why I'm asking is because you know the part of menopause, the psychological and the sexual aspect of menopause, that affects couples and affects relationships. I mean, there's couples and marriages where they love each other. But you know, psychologically, you know, or the women because of the desire. Mismatch, you know, as well as you know depression, you know atrophy. You know, things aren't all of those will affect them the frustration and then and then the men might not understand.
Dr. Mary Claire Haver:they might blame either, uh, the spouse or blame themselves, because they don't understand what's going on right so, uh, how do you? I mean, it's almost like a sort of a couple's therapy that that you have to sometimes do, don't you? Sometimes um or you just refer that to the couple's therapist and you just focus on the medical aspect they, if they're coming into the office, they are coming to learn.
Dr. Daria Hamrah:They are coming. I'm not, they're not coming in for me to be the referee, right? They just want to understand. And so it's less therapy for me and more education and like, how can he help? You know, and really it's coming at it from a place of understanding. This is not her fault. This, a lot of this, is fixable. You know. A lot of this is going to evoke a change. You know and can you adapt to this?
Dr. Mary Claire Haver:yeah, I mean I think that that mismatches what's in between a lot of relationships and you know the lack of understanding from the self-awareness from the women's side, but then lack of understanding from the men's side, not understanding that these symptoms are not related or as a result of you know them being the cause and the fault, and rather a medical condition. You know a physical, medical, physical, physical condition. So any advice you want to share for women that are cynic, are really set in their ways to believe their physicians. That told them yeah.
Dr. Daria Hamrah:Listen to your body. You know that for the vast majority of patients, menopause hormone therapy is safe, but it doesn't. It's not in a vacuum. Lifestyle is very important. You know prioritizing yourself, your needs, your wants, your sleep, limiting alcohol, making sure you're getting up, exercise, you know all of those things are are helpful. But you know if you've been told you can't take hormones, they don't believe in hormones. It's going to kill you. I don't. You know you need to. It's okay to change doctors, even if it was a great doctor who delivered your babies and did great care. There is definitely some bias there that women tend to. You know, I grew, I grew up in the medical system where women, where I was taught, I was taught that women tend to somaticize psychological disorders. This is never true. This is not true. Women are having very real physiological symptoms due to this complete overhaul of their hormones, and just dismissing it as aging or just you know she's being annoying or this should just be a whisper of inconvenience and she's just being dramatic is a mistake and you deserve better.
Dr. Mary Claire Haver:Last question, Mary Claire, what would you tell your own self when you were a OBGYN resident who just is about to graduate next month and so excited about taking on your new chapter, the new chapter in your life and practicing OBGYN and thinking you're going to help a lot of women with their health?
Dr. Daria Hamrah:I would tell her there are gaps in your knowledge. You've learned so much, so many beautiful, wonderful things, but you don't understand what happens when the ovaries stop working. And this is something you're going to have to learn to understand. Or you're not going to help your patients Because I'll tell you, I was a terrible menopause doctor for most of my career. To be absolutely honest, when I think of the words that came out of my mouth, the things that I mirrored and parroted from, I'd heard from other clinicians just have wine, just relax, this will pass. Estrogen might hurt you. You know we're only going to give you this if everything else fails. You know all the patients I put on Neurontin and Clonidine and you know for their hot flashes because I was terrified of estrogen. I'm sorry, I didn't know what I didn't know and I'm making it my job in life to undo that harm that I did to patients.
Dr. Mary Claire Haver:Wow, wow. So I hope your colleagues are listening and the freshly graduating OBGYNs are listening, and I'm sure they are. But that was Dr Mary Claire Haver, and I hope this conversation gave you more than information. I hope it gave you power.
Dr. Mary Claire Haver:If you're going through menopause, just know you're not alone, you're not crazy and you're definitely not invisible. And be sure to pick up her book called the new menopause, and share this episode with a friend, your partner or even your doctor, because you need to spread awareness, shift the narrative for sure and bring women's health into the spotlight, where it belongs. And whether you are a plastic surgeon dealing with women that want to help them with their transformation, a health and wellness doctor, a personal trainer, a nutritionist, a primary care or an OBGYN, I think we have a bigger responsibility and it's our duty to do our research, obtain the knowledge so we can best help them, and rather than blaming the system or throwing our arms helpless in the air and blaming the patient for lack of motivation. So thank you, mary Claire, truly honored to have you on the podcast and keep, keep it going, please.
Dr. Daria Hamrah:Okay, take care.
Dr. Mary Claire Haver:Thank you, take care, bye, bye.