Texas doctor working to improve menopause care in the U.S. with new book

Menopause is having more than a moment. The topic is gaining momentum, thanks in large part to a doctor in Galveston, Texas, who has made it her mission to educate and empower women. 

Dr. Mary Claire Haver, a board-certified Ob-Gyn and the author of the New York Times bestseller "The New Menopause", joined FOX 7 Austin's Rebecca Thomas to discuss.

REBECCA THOMAS: Prior to the release of "The New Menopause", you had already amassed a huge following on social media. So, clearly, there is a real hunger for knowledge about menopause and the not-so well-known precursor, perimenopause. Would you give us a brief breakdown on these stages of life?

DR. HAVER: So, I think most of us understand that menopause is the end of our fertility. It is the end of our periods. But, I don't think what most people understand is when our fertility drops, we actually lose all of our estrogen production from the ovaries for the rest of our lives, and that has some significant effects on us. Besides the cliche, hot flashes for the rest of our lives.

REBECCA THOMAS: Perimenopause, however, starts well before menopause.

DR. HAVER: True.

REBECCA THOMAS: So, talk about that.

DR. HAVER: So, the average age of menopause, which is one year after your last menstrual period, is an average age of 45 to 55. You know the range average about 51 or 52. Perimenopause, which is the transition from normal reproductive cycles to the end, takes about 7 to 10 years for most women. So, it's very reasonable for women between the ages of 35 to 45 to begin her perimenopausal journey and begin having symptoms that begin slowly and then accelerate into her menopause.

REBECCA THOMAS: And, there are so many symptoms beyond the well-known hot flashes. How does the massive drop in estrogen affect women's long-term health?

DR. HAVER: So one of the, you know, really interesting findings that came out of the Women's Health Initiative was that women have an acceleration in their cardiovascular disease risk. And it's mostly because estrogen has a really protective effect on the lining of our blood vessels that surround the heart. And, when the estrogen levels decline, we're more prone to develop, to develop plaques and then atherosclerosis. So that's one of the ways. Our cholesterol levels also tend to rise through the menopause transition, with no changes in diet and exercise, as well as our blood pressure. So, all of those kind of confluences together increase our risk of cardiovascular disease, where in pre-menopause we were lower than men. But, then, in post menopause, we catch up and exceed them.

REBECCA THOMAS: And, speaking of that same study, the Women's Health Initiative (WHI), more than 20 years ago, essentially stopped the use of hormone replacement therapy because of breast cancer concerns. Turns out, that study was flawed and so was the reporting in terms of relative risk and absolute risk. So, what do women and providers need to know about what is more often called menopausal hormone therapy or MHT, now?


DR. HAVER: So, MHT, if you look at modern menopause care and the reinterpretation of the data sets coming out of the WHI and multiple other studies done throughout the world is that for most women, especially in their early menopause, the benefits of menopause hormone therapy are going to outweigh the risks. And, there's just we have, and I joke that it's as resilient as menopausal chin hair, this notion that menopause hormone therapy is only to be used rarely, only in extreme circumstances, and is dangerous when it's actually health promoting. Again, back to WHI, the women who were on hormone therapy had about a 50% per year lower incidence of cardiovascular disease.

REBECCA THOMAS: How can women who are perimenopausal or postmenopausal best advocate for themselves and find a doctor who is well-informed about this stage of life and will listen to them?

DR. HAVER: So, I wish I could tell you that you could just march into your OB-GYN or family medicine or internal medicine doctor and say, ‘hey, let's discuss my menopause and my options for treatment’ because we're not doing a great job currently in the U.S. health care system on providing meaningful clinical education around menopause, its health risks, and what options we have to promote health through the menopause journey. We have a lack of funding, lack of education, lack of training. The WHI kind of made people scared of menopause hormone therapy. So, one, educate yourself. Absolutely. There are lots of great resources. We have a website, of course my book, you know, shameless plug here. There are other good books out there. Number two, find a menopause educated provider. And, one good source for that is going to be menopause.org. That is the website of the Menopause Society where I'm certified. And, lots of the "Menoposse" are certified - so that you know that someone has done training outside of their traditional medical training to learn more about menopause.

REBECCA THOMAS: And, Dr. Haver also has a wealth of free information on her website. That is thepauselife.com. And, of course, on all of her social media channels.