Train Your Brain To Thrive Through Menopause

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Sue Varma, a board certified psychiatrist, distinguished fellow of the American Psychiatric Association, and author of Practical Optimism. They open by taking on a question that sits at the intersection of psychiatry and menopause medicine: why do some women thrive through the most difficult biological transition of their lives, and what can the rest of us learn from them? Early in the conversation, Dr. Varma shares a finding that reframes everything: only 25% of people are born optimistic, and there is actually a gene for it. The other 75% have to learn it. Dr. Varma explains why optimism is not toxic positivity, what practical optimism actually means, and why both extreme optimists and extreme pessimists end up paralyzed into inaction in different ways. She also addresses what happens when depression, anxiety, and brain fog layer on top of the hormonal changes of menopause and perimenopause, and why so many women are being undertreated as a result. Guest links: Dr. Sue Varma https://www.instagram.com/doctorsuevarma/ (Instagram) Dr. Sue Varma https://www.facebook.com/Doctorsuevarma/ (Facebook) Dr. Sue Varma https://www.linkedin.com/in/sudeepta-varma-m-d-p-c-dfapa-8a48286/(LinkedIn) Dr. Sue Varma https://www.doctorsuevarma.com/ Books: “Practical Optimism,” https://www.amazon.com/Practical-Optimism-Practice-Exceptional-Well-Being/dp/0593418948 by Dr. Sue Varma “The New Perimenopause,” https://www.amazon.com/s?k=the+new+perimenopause+book&adgrpid=185684972785&hvadid=779592551415&hvdev=c&hvexpln=0&hvlocphy=9005532&hvnetw=g&hvocijid=18330210678458028246--&hvqmt=e&hvrand=18330210678458028246&hvtargid=kwd-2387728085172&hydadcr=15526_13558562_10471&mcid=8f075e950fa43e08945fd3c1e8259db3&tag=googhydr-20&ref=pd_sl_4itlivvs6o_e by Dr. Mary Claire Haver “The New Menopause"⁠ https://www.amazon.com/New-Menopause-Navigating-Through-Hormonal/dp/B0CKBZ4K1Z/ref=sr_1_3?crid=10GNBSGVPDFJZ&dib=eyJ2IjoiMSJ9.djG88jtefTqLpTg36Li8QIefDxRPHA-WKVyCC9DQ7X71Ad734j96bPWX-yewnsv9Pqm7WCali5P5-h2eixUH_yHkbz1DHy2rQFoQSh7O92HNwttIL_ZBgXVor81D-Z3sbsfBh7JOJXDQwUuhWNnA5LHbsuI1CyhIyjtRm6_DXYJFaWrkYTjJeqJyFBnBZfgTprhlgJe_RZoWH9pOY6S9XzRapnMjnZgOq7PBA7Wy2KM. ZfI9WXwN58225D-i3qDhw4ZlXZO4pt8rPX1nAKiBNHM&dib_tag=se&keywords=perimenopause+book+mary+claire&qid=1775810714&sprefix=perimenopause+book+mary+claire%2Caps%2C511&sr=8-3 by Dr. Mary Claire Haver “Joyspan,” https://www.amazon.com/Joyspan-Science-Thriving-Lifes-Second/dp/1546007350 by Dr. Kerry Burnight “The Relaxation Response,” https://www.amazon.com/Relaxation-Response-Herbert-Benson/dp/0380815958 by Dr. Herbert Benson For full show notes, please click here https://thepauselife.com/blogs/the-unpaused-podcast/train-your-brain-to-thrive-through-menopause.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  I want to be clear that what optimism is not telling someone, just look on the bright side, right? That's what we often associate with optimism.

• 0:08Dr. Mary Claire Haver?

  Yeah.

• 0:08Speaker 00

  No, everything will work itself out.

• 0:10Dr. Mary Claire Haver?

  That seems toxic to me.

• 0:11Speaker 00

  Hundred percent, right? That is toxic positivity. Telling someone to look on the bright side without first understanding the depths and the gravity of what they have been through, right? Like that, to me, is dismissive at best or toxic positivity at worst. Optimism simply says that there is the potential for good things to happen, right? And we, practical optimism says, let's turn those positive outlooks into positive outcomes through action.

• 0:50Dr. Mary Claire Haver?

  The views and opinions expressed on UnPaused are those of the talent and guests alone and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment. My guest today is Dr. Sue Varma, one of the foremost mental health authorities in the country, and I have been wanting to have this conversation for a long time. Dr. Varma is a board certified psychiatrist, cognitive behavioral therapist, couples therapist, and psychopharmacologist in private practice in Manhattan, and a clinical assistant professor of psychiatry at NYU Langone. She is also a distinguished fellow of the American Psychiatric Association, which is the highest distinction

• 1:35Dr. Mary Claire Haver?

  that organization bestows. And she is the author of Practical Optimism: The Art, Science, and Practice of Exceptional Well-Being. Before any of that, she was the founding medical director of the World Trade Center Mental Health Program at NYU Langone. She sat with civilian survivors and first responders across every point in the trauma continuum, from complete devastation to some of the most remarkable resilience she has ever witnessed. And she started asking a question that I think about in my own practice. Why do some people thrive despite profound adversity? And what exactly are they doing that others are not? That question is why she's here today. Because I see this in my clinic every single day.

• 2:19Dr. Mary Claire Haver?

  Women navigating one of the most significant biological transitions of their lives, often without any support, often having been dismissed for years and being told that what they're experiencing is all in their heads. And here's what I cannot stop thinking about. Same labs, same symptoms. And while some of them are falling apart, others are still standing, still building, still showing up fully for their lives. I want to know what is in their toolkits. And then I want to figure out how to give it to every woman who walks through my door. I'm Dr. Mary Claire Haver, a board certified obstetrician gynecologist and certified menopause practitioner. I'm also an adjunct professor of obstetrics and gynecology at the University of Texas Medical Branch.

• 3:03Dr. Mary Claire Haver?

  Welcome to UnPaused, the podcast where we cut through the silence and talk about what it really takes to thrive in the second half of life.

• 3:20Dr. Mary Claire Haver?

  Dr. Suvarma, welcome to UnPaused.

• 3:22Speaker 00

  Thank you. So great to be here.

• 3:24Dr. Mary Claire Haver?

  So we're going to jump right in. So early in my clinical practice, when I was just out of residency and before I really understood the neuropsychosocial effects menopause could have on a woman. These women would come in somewhere in midlife, anxious, struggling in a life that they'd built, that they were previously managing really well. And I didn't know enough to say, oh, maybe this is perimenopause, or maybe this is hormonal. And I just would send them home with a pat on the shoulder and it's all in her head. Right? And then your work and realizing, you know, some of the later data on how menopause affects the brain, you know, made me realize we're kind of asking the same questions in our work.

• 4:09Dr. Mary Claire Haver?

  Like, this is a really significant biological transition for women, and some of them are absolutely thriving through it and doing great, but a lot of them aren't. And like, what is the difference? And what is the toolkit that they need to make that happen? So take me back to the World Trade Center Mental Health Program. You were the first medical director there?

• 4:30Speaker 00

  Yes.

• 4:30Dr. Mary Claire Haver?

  What did it actually feel like to sit with those people? I can't imagine.

• 4:35Speaker 00

  Heartbreaking.

• 4:35Dr. Mary Claire Haver?

  Yeah.

• 4:36Speaker 00

  So on nine 11 itself, I was a medical student and I was training in a New York City hospital. And I remember being in a patient's room when literally on the TV, you're seeing the first plane crash. And like you're stunned, you're speechless, like we're all looking at each other. And then next thing we know, we hear an attending say on the loudspeaker, discharge, discharge, discharge. Anyone that can go home, that's well enough to go home, send them home because we were expecting thousands of people. And in the hours afterwards, anyone that could go home, that already had a discharge plan in place, went home. But we waited, we waited and we waited and no one came.

• 5:20Speaker 00

  And it was so devastating, so devastating because people there that day had family members who were working in the World Trade Center colleagues. You couldn't get through to anybody, cell phone lines were crossed. So in the days after myself, friends, my now husband, boyfriend at the time, we all volunteered in whatever capacity we could. Some of us went to the morgue, some of us went downtown, some of us got trauma training, which is what I did. I knew I wanted to go into psychiatry. And so when I'm becoming the medical director, it wasn't at that moment. It was years later after finishing my psychiatry training. And I got recruited for this program and I was like, wow, there are other bigger world experts who have training.

• 6:03Speaker 00

  And they were like, no, you're the person we want for this position. And it was a very humbling experience because I'm a New Yorker, born and raised. Like I very much feel connected to what happened, but it didn't matter where you lived at the moment. I think, you know, no matter what part of the country you were, we saw with nine 11 that when it comes to trauma, simply being exposed to images on TV. Right? Like that stress, it is contagious. There's something to be said about that. And so I'm meeting these folks and I've known what they have gone through. Right. And when we look at trauma and we look at the number of losses that you've had. So if you have lost your job, if you had health problems. And most of the patients coming in had multiple health problems. So they were living down there. There were folks who were involved with a rescue and recovery.

• 6:47Speaker 00

  So I treated first responders at that time. We only had one program. So I was treating both civilians and people who were working and living down there. And police fire all of firefighters, all of it. And the more losses you had, so if you had asthma, you had GI problems, insomnia, PTSD, anxiety, domestic violence, substance abuse, job loss, financial loss, physical limbs, you know, lost, family members died. All of that just added to the level of stress. And a lot of these people had prior history of trauma in their life. So we saw that women were more impacted than men. Women are more likely, two times or more likely to have PTSD. And how you managed in the aftermath, what was the story you told yourself?

• 7:33Speaker 00

  That really had an impact. So, so much of what I learned in meeting these patients, believe it or not, were not only the patients that I treated, but I think I learned more from the patients who never actually made it into our program. So there were a group of patients who would get screened every year for anxiety, for depression, for PTSD, and they never met criteria. So I was like, what is going on? Who are these resilient folks that are so buoyant that like they went through one of the most devastating calamities in our history? And yet they're smiling, they're coming to the clinic and bringing patients with them who were too scared to leave their home. Cause that happens, a lot of people didn't want to take public transportation. They didn't want to come to the city.

• 8:13Speaker 00

  And that's typical in trauma, that the avoidance, hypervigilance, nightmares, flashbacks. So they had agoraphobia, they didn't want to leave. They didn't, they couldn't even make their medical appointments, even though they desperately needed it. And yet there was a subset of folks who went through the same losses that day and yet came in. Healthy, happy and supportive of the other people. So I said, these are the people that I need to study. I want to treat my patients, but I want to, I want to understand who are these people and what they're doing right? And over the course of the years, I realized that they had this sort of optimistic framework on life, which was this idea that bad things can happen. There's an acceptance, right? And that's why I call it practical optimism, because it's not just accepting and resigning.

• 8:58Speaker 00

  Cause a lot of extreme optimists, they do that. They just resign. They say like, oh yeah, things will work themselves out. But practical optimists say they're very aware of the negative things that can happen, but they're prepared to handle through their agency, through their problem solving. Right? They're very clear through their processing. So I, I basically had come up with these eight pillars. What do these people do? What, how can I learn? Cause I don't consider myself a natural born optimist, right? Like, and I learned when we wouldn't know that at the time, but years later that there's a genetic component to optimism. Right? Like only 25 of us or 25% of us are born optimistic. The rest 75% have to learn it. And this genetic component is that the O X T R gene or the oxytocin receptor gene, right?

• 9:41Dr. Mary Claire Haver?

  Wait, what?

• 9:42Speaker 00

  Yeah.

• 9:42Dr. Mary Claire Haver?

  There is a gene for optimism?

• 9:44Speaker 00

  There is. And you know, you doing the work that you do oxytocin is such a part of, right? And, and who would have ever thought that?

• 9:51Dr. Mary Claire Haver?

  Explain to our audience what oxytocin is.

• 9:53Speaker 00

  Yeah. So oxytocin is a cuddle and bonding hormone that you see, you know, in orgasm, in cuddling with your baby. And it's what bonds us.

• 10:00Dr. Mary Claire Haver?

  What makes the milk let down, you know, what triggers labor? We, yeah, we use oxytocin a lot.

• 10:07Speaker 00

  And oxytocin, you're hugging a friend, like it's the social glue, the connection in our society, bonding between mother and child, breastfeeding, sex, all of it. And that this oxytocin receptor gene codes, what was so interesting to me was that really what it codes for is social skills, the ability to ask for help, right? Agency, and this is something that all of us can learn. So even if you didn't fall into this 25% glass half full mentality.

• 10:38Speaker 00

  You were born with a set of skills that some people have, but the rest of us who are not born with it, 75% are not going to be born this way. 75% of us are going to be more at risk for depression because we have this glass half full thinking. If you don't stop your pessimism in its tracks, it will lead to depression. That is a fact. The question is, how much pessimism, right? So I'm all about risk management is just trying to narrow the amount of pessimism that you have, trying to catch it early and trying to flip the switch on it.

• 11:09Dr. Mary Claire Haver?

  I'm still, I'm still like processing that we have a gene for this. Okay, keep going. I am so, so practical optimism, that practical word's doing a lot of work. I was always under the assumption that this was, some people were just born this way and the rest of us were not going to be happy.

• 11:27Speaker 00

  Yes.

• 11:27Dr. Mary Claire Haver?

  But that's not true.

• 11:29Speaker 00

  That's not true. And so the interesting thing is, so I want to be clear that what optimism is not telling someone, just look on the bright side, right? That's what we often associate with optimism.

• 11:40Dr. Mary Claire Haver?

  Yeah.

• 11:40Speaker 00

  Ah, everything will work itself out.

• 11:42Dr. Mary Claire Haver?

  That seems toxic to me.

• 11:43Speaker 00

  Hundred percent, right? That is toxic positivity. Telling someone to look on the bright side without first understanding the depths and the gravity of what they have been through, right? Like that to me is dismissive at best or toxic positivity at worst. Optimism simply says that there is the potential for good things to happen, right? And we, practical optimism says, let's turn those positive outlooks into positive outcomes through action. So there are a group of people who are, have blind optimism, right? That's not what we're talking about. That extreme optimism where the person, I'll give you an example, and you must see this in your practice. I see this a lot in male patients, right? And family members that I know who go to their primary care doctor and the doctor will say, yeah,

• 12:27Speaker 00

  there's some things, you know, your, your numbers are a little bit off, your hemoglobin A1C is a little bit high, your cholesterol. And the patient comes home hearing, it'll all work out. Nothing is too bad right now. I'll figure.

• 12:37Dr. Mary Claire Haver?

  Like I can make a few changes and we can, yeah.

• 12:39Speaker 00

  Yeah. Or the doctor's like, I'm not so worried right now. Let's come, come back in three to six months. And they don't change anything because they bury their head in the sand because they're so positive. They think they will.

• 12:48Dr. Mary Claire Haver?

  Okay, they, yeah.

• 12:48Speaker 00

  They think it'll all.

• 12:49Dr. Mary Claire Haver?

  It'll be fine.

• 12:50Speaker 00

  It'll be fine. And they're dismissive, right? And on the other hand, I have a lot of patients with severe health anxiety where they'll say, I know I have a mammogram due this year. I have not scheduled it. And I was like, what are you waiting for? It's going to be horrible. I said, tell me a little bit more. Where's this thinking coming from? Just give me, give me, what does the evidence suggest in your family? Does who has breast cancer? Who has cancer? No, nothing, nobody. I just cannot deal with the, the knowledge. So that extreme pessimism that it's going to be horrible. I'm going to get cancer. I'm not going to be able to handle it. That is the extreme pessimism and the pessimism pessimists also don't act. So if you see these two ends of the spectrum, the extreme optimist buries their head in the sand because it'll all figure itself out. The extreme pessimist is engaging in avoidance and procrastination and also burying their head in the sand because they don't want to see

• 13:35Speaker 00

  potentially the bad things, right? And they also end up getting frozen in their tracks.

• 13:39Dr. Mary Claire Haver?

  Mm hmm.

• 13:40Speaker 00

  And what we need instead is to marry a little bit of healthy skepticism, right? That the pessimists bring because we do know that pessimists are more accurate, right? They do more thorough research. The problem is they become paralyzed.

• 13:51Dr. Mary Claire Haver?

  Yeah.

• 13:52Speaker 00

  Into inaction and marrying the two. I always say that optimists build the planes and pessimists build the parachutes. And we need both.

• 13:59Dr. Mary Claire Haver?

  All right, let's talk about how we, and I'm thinking me, can make a mess of things. Like what I see in practice and especially like the conversation around waking, right? Patients know, we don't have to tell them, work out more, eat less, you know, patients know I shouldn't smoke. Patients know I should do these healthy behaviors, especially if they're on social media, right? But they can't seem to make themselves do it, right? And so neurologically, psychologically, what's actually happening in that space?

• 14:32Speaker 00

  Uh huh. So 75% of the time, people know what to do. If you ask them, what are the exercise guidelines? What's the nutrition plan? What do you, what should you be eating? They know it. The problem is that we make each individual, we make 30,000 decisions a day. And two, and 200 of them are about food, right? The problem is that every time you are reinventing the wheel, when you're making a decision, okay, I'm waiting for my motivation to happen, right? I'm, I'm, I'm waiting for some inspiration for me to go to the gym. You are then engaging your prefrontal cortex and that is your CEO. It is very expensive. You will not be asking your CEO to clean the toilets. I hope not, right? Like that's a mismanagement and a poor use of resources and poor use of cognitive resources.

• 15:16Speaker 00

  So the prefrontal cortex should make a decision one time. And that is where your intentions lie, your goals, your big picture thinking. In order for a Behavior to stick, it must become automatic. There has to be this switch from intention to automation. And we can talk about one of the steps that are involved. But the reason, the big picture thinking behind the automation is that then that behavior becomes bundled and it becomes this sort of package that then lives in your basal ganglia. And that is

• 15:47Dr. Mary Claire Haver?

  And for our audience, what is the basal ganglia?

• 15:49Speaker 00

  It's like the more primitive brain and there's not much thinking involved. So if you're somebody like I have never, for me, my basic thing that I don't even think about brushing the teeth in the morning and brushing the teeth at night, like that automatically happens. There's no expenditure, right? So it's free. So if you want to be able to, because I think in midlife, so many of our resources mentally, right? We're so tapped in so many different directions. Not only because we're the sandwich generation, like half of people in their 40s, 60% of women especially are part of this generation where they're taking care of elderly parents and minors at home potentially, like less than 18. So we're the sandwich. The stress is on both sides. We already have a lot of things pulling on us cognitively, managing a lot. So the last thing you want is your basic health habits to not be automated. Right?

• 16:34Speaker 00

  So you just want it on like a regular feedback loop. And if you, even something as simple as putting your sneakers on, that is the first step. So that the basal ganglia, that part of your brain that has that habit automated, it's like, oh, I know where you're going. I will take over from here. I've got this. Like, I'm just thinking back to the early days. If you had help when you were raising your daughters, if your mom like that feeling when you're relieved in the morning, when you've woken up at four, five 30 and somebody comes to your front door and they're like, I got this, you can go to work. Right? It's that, that's what the basal ganglia will do. And the way to do that is to simplify by lowering the entry barrier. So I think one of the biggest mistakes I see is that people say to themselves, I'm going to start doing a 5am hot yoga class. I was like, all right.

• 17:18Dr. Mary Claire Haver?

  Yeah, they over commit.

• 17:19Speaker 00

  Totally. And I'm like, do you like yoga? No. Do you like hot yoga? I like it even less. Do you like getting up at 5am? No way. So I was like, help me understand how this is going to happen. I am not personally a 5am hot yoga class. But what I am is a, you know, 11am cycling person. I might be a 4pm gym person. I might be a, so, so do what's realistic by lowering the entry barrier. If you're not a morning person, don't do it in the morning. Whatever it is that you're not a person of, don't do that. And what is the, make it too small to fail. Not too big to fail, make it too small to fail. So lowering the entry barrier. Doing something with a friend, we have seen studies where you take two people and you say, all right, let's say you're going to climb this incline. They show a person a fictitious incline.

• 18:03Speaker 00

  Are you capable of doing it? What do you think of this incline? Knowing, even if their friend isn't there, just invoking the idea of doing an incline with a friend, all of a sudden made the incline steep, perceptibly lower and less difficult. So just the knowledge of I'm not alone. I've got somebody with me, supporting me, someone who's got my back, someone who's encouraging me, somebody wants me to win. That is going to make you more likely to take on challenges and to perceive those challenges as being far less. One of the biggest things that happens in anxiety is, or worry, or not being able to start a new habit, is that we overestimate the magnitude of the challenge, of the problem.

• 18:43Dr. Mary Claire Haver?

  Okay.

• 18:43Speaker 00

  And we underestimate our ability to handle it. And I think that's something that really happens to a lot of women midlife. When you were talking about this switch of someone who can, so capable. What's happening and where we're losing self-esteem is that all of a sudden, everything seems insurmountable.

• 18:59Dr. Mary Claire Haver?

  That, yeah. I describe it, my patients, you know, it took me years to figure out this pattern. But, you know, these were high performing, very complicated lives, and they had it managed. Like the ups and downs, the normal day to day stuff. And then the patients were coming in saying, I don't feel like myself. I feel like the rug's been pulled out from under me. And suddenly, these day to day tasks become insurmountable for them. And then they get paralyzed.

• 19:27Speaker 00

  Totally. So how can you reduce the magnitude of the problem? Just the perception of it, right? And then boosting your sense of can-do-ness, your sense of agency. So it's that gap that feels so big. And so there are several ways of doing it is, you know, number one, breaking the task. I remember, my dad's a child psychiatrist, and I remember this trick that he would always do with us. And it got old after a while. I got the point after the first time. But, you know, he would take a stack of those number two pencils that we used to fill out our Scantron sheets with, right? And he would wrap a rubber band around it. And if I would tell him my problem, he would literally pull out that stack with the wrapper of a band around it. And he's like, take the stack. And I took it from him and he's like, break it. And I'm like, Dad, there's like 12 pencils. What do you want me to break?

• 20:11Speaker 00

  And then he's like, break it. And I'm like, I can't. And then he's like, I didn't give you any rules. Do what you want. And I was like, ah, I get it. You want me to take out one pencil at a time and break one pencil at a time. So just ask yourself, what am I doing right now? Because I do this a lot. I look at a big problem and I'm like, I can't because there's forty steps involved, right? So if your plan is I want to commit to an exercise, whatever, forget about figuring out which gym you're going to sign up for. So there is something called, I don't know if you've heard this term, satisficers or maximizers.

• 20:47Dr. Mary Claire Haver?

  No.

• 20:48Speaker 00

  So this has to do with like, okay, I would love it. There's, I have a little quiz in my book, but basically it's asking you, what is your decision making style? Are you somebody who likes to do a lot of research and wants to know every little detail about something? Because my mom was like that. Trying to find a car with my family shopping, impossible. But does this have a moon roof? I'm like, Mom, when did you need a moon roof? Are you like, going to be dancing out of the ceiling? She's like, no, but I just want to make sure that we get a good deal, right? And the horsepower. And I'm like, do you, what do you actually need? My dad, on the other hand, and a lot of men, when they shop, they're satisficers, good enough. And it's like a combination of two words, like this is satisfactory, sufficient, and it's, it'll get the job done. My dad would go anywhere and just the store, like, that's why the men's clothing, you know, it's at the front of the store because they go in and they're, they know what they want and they're done. Is this good enough

• 21:32Speaker 00

  for now? So if you're trying to walk, forget about the gym, because I'll do this a lot. I'm a maximizer. So I'll try to look optimized for everything. Oh, is the membership good? Can I get out of it easily? What's the cancellation policy? And I'm like, girl, just start walking, right? Like, that's free. That doesn't take a lot. So lower the entry barrier, lower the number of decisions that need to be made. Because a big part of habits is this idea of identity formation, like, is this behavior a part of who I am? And the easiest way to do that is just to start acting in a very small way. If you're someone, let's say you live in an apartment building, and climbing stairs is the only activity that you can do in the stairwell of your building, do it in your home. If it's the five minute walk,

• 22:12Speaker 00

  anything that you can automate, even if it is very small and inconsequential to anybody else, just that idea that I walk after meals. That's the big thing I'm hearing is like to, the glucose spikes, if you want to manage.

• 22:25Dr. Mary Claire Haver?

  The data around a thirty minute walk after dinner is like astounding.

• 22:28Speaker 00

  Start there, you know, because you will then be the walker in your mind. And that is so important because again, that identity formation. So when I was talking about that, we want to take it out of the prefrontal cortex, which is, oh, my God, there are 100 steps involved. I gotta find out about the cancellation policy of the gym. And if I go on vacation, you know, all of those micro details, it is too much expenditure. You want to make it in the simpler, more reptilian part of the brain, which is, let's just get this done. There's no thinking involved.

• 22:55Dr. Mary Claire Haver?

  Mm hmm.

• 22:56Speaker 00

  And every time you take a step, there's like a little bit of dopamine surge. And that dopamine surge says, starts to facilitate and lay down tracks, you know, in the neural pathways so that it becomes automatic. There's no thinking involved. So we do get a little boost of dopamine. People are thinking, I need to wait for motivation to strike me like lightning.

• 23:17Dr. Mary Claire Haver?

  Mm hmm.

• 23:18Speaker 00

  Right? And what we don't realize is this concept in therapy called behavioral activation. You put the cart before the horse. You know when motivation comes? After you act. Action gets more action.

• 23:28Dr. Mary Claire Haver?

  Mm hmm.

• 23:29Speaker 00

  We found that people who exercise regularly have a greater sense of purpose in life. And people who have a sense of purpose in life are more likely to exercise. So if you don't feel a sense of purpose today, go for a walk. Go for a 15 minute walk. You're going to come back energized. You're going to have a sense of agency. I'm a capable person. I get stuff done. What did you do? I went for a walk. That was the most important thing.

• 23:51Dr. Mary Claire Haver?

  That's all you did.

• 23:52Speaker 00

  Yeah. And when I tell this to patients, the first time they laugh at me. They're like, Dr. I mean,

• 23:56Dr. Mary Claire Haver?

  Well, I mean, the mentality is like, what's the point? It's a 15 minute walk. It's not going to burn any calories and da, da, da, da. But like, it's not the point.

• 24:02Speaker 00

  No.

• 24:02Dr. Mary Claire Haver?

  You know, I think we're missing the point of exercise.

• 24:04Speaker 00

  Yes, and of agency and making you believe that you are a capable person and making it a part of your identity. Because one thing I should say is there's this whole idea of the default mode network. And maybe we can talk about that. And that is the ruminating part of the brain.

• 24:20Dr. Mary Claire Haver?

  Buy smart, drive for less and trade for more. That's Toyota affordability and it all starts with a great deal from your local Toyota dealer. Make a smart buy on an all wheel drive Camry, Corolla Cross, or get a Corolla sedan packed with the latest features, advanced tech and head turning style. Take a test drive in two of Toyota's most popular SUVs. The spacious, family friendly Grand Highlander and adventure ready RAV4. And with so many hybrid and plug in hybrid models available across the lineup, plus efficient all electrics like the BZ, BZ Woodland and all wheel drive CHR, you can drive your way and skip the pump. And long after you leave the lot, your Toyota keeps delivering

• 25:05Dr. Mary Claire Haver?

  with legendary resale value built on a reputation for quality and reliability. So when it's time for your next Toyota, you could trade in for more. From a great deal today to a great value tomorrow. A Toyota is right for you. Shop toyota.com for deals and details or stop by your local Toyota dealer today. Toyota, let's go places.

• 25:33Dr. Mary Claire Haver?

  So you had mentioned the ostrich optimist, the person who buries their head in the sand. I see a version of this in clinic. A woman who's been told nothing is wrong so many times. You know, she's seen six, eight, 10 providers and they're all like, you're fine. Your labs are normal. And then she accepts that that's, that's her, you know? Is that an ostrich optimist as well?

• 25:57Speaker 00

  I mean, they can become that. I mean, to me that feels like gaslighting, right? Like being told you're fine and you're minimizing and dismissing a person. So that's more like, I understand that the doctors are well intentioned.

• 26:09Dr. Mary Claire Haver?

  They weren't trained, right?

• 26:10Speaker 00

  And it's limited, right? So they're just going off of the knowledge I have. And for some people that can be reassuring to say, okay, at least I know it's not something that's within your domain. These are the five doctors I went to and there's nothing in their domain that they can fix. Cause that's, that's what I would say, but I would tell this woman to. To not be the ostrich optimist, right? Because you clearly know that there is a disconnect between how you feel and how you want to feel. And that, to me, is where motivation comes in.

• 26:36Dr. Mary Claire Haver?

  I don't think women feel like they have permission

• 26:40Speaker 00

  Mm hmm.

• 26:40Dr. Mary Claire Haver?

  to want to feel differently than what they're being given.

• 26:44Speaker 00

  Yes, I'm going to say something which sounds contradictory to what I want to say. On one hand, I think a sense of acceptance in life is important, right? Like, change what you can and accept what you can't. I remember one of the things that came out of my work with nine 11 survivors was telling somebody like, you know, just go back to work. And they're like, but the world is not a safe place, you know? And how do you argue with that, right? Like, there could be another attack tomorrow. How do I know? And I realize that as a therapist, like, I also have to create room for acceptance. That one of the things I learned in my eastern upbringing is a question to ask yourself when you feel super, super frustrated and you feel like there's nothing else you can do.

• 27:25Speaker 00

  Ask yourself, is this a problem to be solved or a truth to be accepted? So if you've lost someone, a loved one, and you're grieving, you can't bring them back, right? You can't undo a tragedy or a horrific situation. So in those circumstances, when I feel, I say, when a person feels completely helpless and they have tried every which way, I think in those moments, sometimes acceptance is useful. But at the same time, that's where the practical optimism comes in. It's like acceptance for now, right? So like, let's say I've come, come back from my fifth doctor's appointment and everybody is saying to me, there's nothing, and that's happened to me, you know? I, we, I've shared that with you, like, I had a problem and doctors are telling me, you're, you're fine. But I knew that something was not fine.

• 28:08Speaker 00

  But for that day, I was like, I just need to go home and sleep, right? Like, I have been through a lot. So there, so it's okay to have micro buckets of acceptance, right? In that one day, you've come back from your fifth doctor's appointment. And on one hand, you feel reassured, okay, it's nothing.

• 28:21Dr. Mary Claire Haver?

  I'm not dying.

• 28:22Speaker 00

  I'm not dying, yeah. And then on the other hand, you're like, I will come back to this tomorrow, which is, but I'm not, and I need to continue my search. So I think a lot of times, for example, with therapy, people, people dismiss therapy and they're just like, I'm done with it because they had one bad experience. Or two or three, and I say, keep looking, right? Like it's, it's you keep looking for that provider that can see you, that has the expertise, that is trained, watch videos, get recommendations and referrals from other people, but don't give up. So yes, there is an element of the ostrich, but I also just feel like this woman is also being gaslit.

• 28:56Dr. Mary Claire Haver?

  Yeah, which I guess makes it worse.

• 28:59Speaker 00

  Yeah.

• 28:59Dr. Mary Claire Haver?

  You know, there's a cycle that you described that I want to make sure we cover clearly for everybody listening. The woman who cannot follow through on her commitments to herself and that failure, like she just, the shame starts.

• 29:12Speaker 00

  Yeah.

• 29:12Dr. Mary Claire Haver?

  You know, and what society is telling her she should be doing. And God forbid she gets on social media and looks at these unrealistic expectations.

• 29:20Speaker 00

  Mm hmm.

• 29:20Dr. Mary Claire Haver?

  How do you break that cycle?

• 29:22Speaker 00

  So I think first recognizing what that emotion is, which is the shame. Shame is very toxic. And you've internalized other people's values and they're not necessarily even your own. And I was mentioning the idea of the default mode network, which is it's a part of your brain that's active when nothing is happening, when you're just sitting there and you're daydreaming. And it's meant for you to sort of have some introspection and, you know, self referential thinking, what we call like thinking about yourself and your habits and awareness of the self. It's what's happening in your brain when you're not doing an activity. But in these negative loops, it can go down and you can start ruminating and you can say, I'm hopeless. I am helpless. What's wrong with me?

• 30:06Dr. Mary Claire Haver?

  I see it in clinic and that's the main reason I'm pulling out tissue for patients is there is so much shame and they feel like failures. Their body's failing them. They're not able to, you know, commit to the nutrition, the exercise, but like also they're, they're, they're struggling in every relationship as well with their children, with their parents, you know, and all of this is being stacked on top of them.

• 30:32Speaker 00

  Yes.

• 30:33Dr. Mary Claire Haver?

  And they keep taking on more and more and they just can't manage it.

• 30:35Speaker 00

  Yes. So, you know, it's not something, especially I think if you've been conditioned. To think that you must be a high performer in every aspect of your life. So some of it is these narratives and these scripts that we've been given. You know, I know I grew up with that, you know, like you have to serve everyone else. Yeah. So it's like you're dismantling and deconstructing an entire worldview. Right. And it's collapsing and it is an opportunity, I think, for a rebirth of sorts. To say, once something collapses, it's like, imagine, I would hate for this to happen to anybody. Right. But let's say your, your house just, I mean, that's a tragedy, right?

• 31:13Speaker 00

  But like, using it as a metaphor, it collapses and they're like, okay, here's some insurance money to build your dream house. What do you want to do? We're gonna, we're gonna put you up somewhere temporarily. We're reconstructing this house. We're rebuilding it. And I look at therapy as an opportunity for that. Like, a person may come to see me because of a job loss, because of a divorce, because of a relationship problem. They come in for one specific problem, but then I say, let's look at the rest of your house. Let's look at the foundation. What is the foundation on which this house, your whole self-esteem, your whole sense of self and character is built on? And self compassion is not woo woo. There is so much science behind it. When we look at self compassion involves saying to yourself, I'm aware of these negative thoughts.

• 31:58Speaker 00

  I'm just going to be aware of them. No one is saying that I, that they're true. I'm just going to be aware of all of the negative things I'm saying to myself. Then on some level, there's going to be a certain amount of acceptance that I think I'm a shitty person. All right. Now what? What are you gonna do? It's like, imagine you're talking to somebody else. You're like, all right, bring it on. Say what you have to say about me. Once there's a certain amount of acceptance of the negative self-talk, but also a desire to want to rewrite this, you then start to say, you have to say to yourself some form of self compassionate, like rewriting the scripts. I have been dealt too many cards. I am going through a lot of changes in my body right now. It is not my fault. This is very unfair. I say this to my husband. I'm like, you are lucky that you get to keep a lot of your testosterone or whatever, you know, like,

• 32:43Speaker 00

  until you're god knows how old. Like I have said to him, I feel like this is very unfair to me. Why are the hormones that are not just for reproduction, right? I'm done with that aspect of my life. I have kids, but I, I need my estrogen and my progesterone to function. I want to functional, function at my maximum capacity. I feel like this is the stage when you're in your 40s and your 50s, when you have maximum regenerative capacity. They talk about IQ. They talk about empathy. They talk about. Resilience worldview, we know that there's a dip in our happiness. There's like a U-shaped curve where forty seven, they say forty eight is the lowest point of that happiness. And it's only going up from there afterwards because we do an audit.

• 33:24Dr. Mary Claire Haver?

  Well, let's go back to that.

• 33:25Speaker 00

  Yeah.

• 33:25Dr. Mary Claire Haver?

  Hold on, hold on. Where's this from? What, the graph?

• 33:27Speaker 00

  Like, yeah.

• 33:28Dr. Mary Claire Haver?

  I see this clinically, but I've never heard anybody talk about this is the nadir for women.

• 33:33Speaker 00

  Yeah.

• 33:33Dr. Mary Claire Haver?

  And that is the age of peak perimenopause.

• 33:35Speaker 00

  Yeah.

• 33:36Dr. Mary Claire Haver?

  So the maximum zone of chaos. So go back to that graph.

• 33:38Speaker 00

  Yes, so looking at populations and happiness, like, you know, of course, it's subjective ratings, but forty seven, forty eight is the lowest point. I mean, when you're younger, you think your whole life is ahead of you. You're in your twenties and by your forties, whatever plans that you started out with, sometimes they don't work out. Sometimes the plans that you had, like, I'm going to have this marriage or this have children or this job or financially. So some of it is what's happening in the, in your life outside. And some of it is also the changes hormonally, but it's, but it's with men and women, right? So it's more than that. It's sort of like midlife, I think you're taking an audit of this house and this foundation and do I like it? Do I like me? Who am I? We become the sandwich generations. We're not really in touch with our friends.

• 34:20Speaker 00

  Like, you know, I think about when kids are in college, that's the time, high school, college, when you are in your peers' company. And that's the most amount of time you'll ever spend with people your, your own age. And then it's like, when it comes to friendships, it's kind of downhill from there. I hate to say it. And we do know that if you want to look at somebody's health in their eighties, look at what their friendships and their relationships like, or like in their fifties. And that is going to project peak health, like, and this whole midlife period. I feel like this is such an opportunity for us to revisit all of these values that have been handed to us and reconstruct and rebuild. And there is a rebuilding. So from forty seven to forty eight, from this nadir, the U goes back up because then you, the people that you do take, I don't want to say take back, but that you invite back into your life.

• 35:05Dr. Mary Claire Haver?

  Yeah.

• 35:05Speaker 00

  You choose.

• 35:06Dr. Mary Claire Haver?

  I mean, boundaries.

• 35:07Speaker 00

  Yeah.

• 35:08Dr. Mary Claire Haver?

  Yes. I've done this, exact thing. I was at my absolute lowest, I think, at forty seven to forty eight. And had to rebuild. And now I'm a menopause specialist. And now I have built this incredible life. I've put up boundaries. I've cut people out of my life that didn't make me happy, you know, and my own family members. And, and it's okay. And I've given myself permission to stop asking for permission for every single thing that I do.

• 35:35Speaker 00

  I love that. Do you know, do you remember what it was? Was it a single moment or a decision? Or how did you feel empowered to be like, I'm now living?

• 35:43Dr. Mary Claire Haver?

  My brother's death. So I lost, I've lost three brothers. One when I was nine and he had leukemia. And then in 2015, I lost my brother Bob due to HIV and hepatitis. And then in 2020, I lost my brother Jude.

• 35:59Speaker 00

  I'm sorry.

• 36:00Dr. Mary Claire Haver?

  And to esophageal cancer, stage four. And that, those were like watershed, plus I was like coming out of the fog of menopause, like taking back control back of my life, you know? And I may not get these years. I'm like, you know, so Bob was nine years older than me and I just turned 57 and will outlive both of them. So all three of my brothers. So this is the year. And I was on a mountain in Norway hiking with my husband and our two of our closest friends on my birthday. And I remember climbing up this mountain and being like, this is the year.

• 36:35Speaker 00

  Wow.

• 36:36Dr. Mary Claire Haver?

  This is it. And like, look at where I'm at. Look at where I am versus 10 years ago. I've built a huge community. I've, you know, conquered this social media thing. I've, you know, practicing the medicine I was born to practice. And I, I made up the rules myself, you know, and wow, built a company, you know, after age 50. It was just like this incredible moment for me.

• 36:56Speaker 00

  Totally. That's so beautiful. You took the time to, like they say, like enjoying the view, like, at that moment, to be able to take in a perspective and also gratitude that like.

• 37:08Dr. Mary Claire Haver?

  I have my therapist, you know, which I got way too late, but I have learned gratitude to practice gratitude and like get up in the morning. It's what I do first thing. It's like, what am I grateful for today? I used to write it down. I can do it in my head. And it's usually the same thing every day that I have a job that I love. I don't feel trapped. I don't feel stuck in my life. That I have a beautiful family. My kids are healthy and thriving. You know, I have a 33 year relationship that's still thriving. I have.

• 37:37Dr. Mary Claire Haver?

  You know, financially stable. Thank God I'm healthy. I'm healthier than I've ever been in my whole life.

• 37:42Speaker 00

  And beautiful thing is like you, you built it, right? So like, I always struggle with this idea of gratitude in the sense that like, okay, I can be grateful.

• 37:50Dr. Mary Claire Haver?

  People gave you things.

• 37:50Speaker 00

  Yeah. But it's like, if you built this, you can still be grateful, right? You can, because you have the means, the resources, the mental wherewithal, the emotional capacity to create the life and the support, that combination. So it's like, very much something that you created, you envisioned, but you can still be grateful for it.

• 38:08Dr. Mary Claire Haver?

  Yeah. Oh, I totally am. I know it can be taken away. My health could go, my family's health could go. You know, we've lived through that. And so I'm just, I'm grateful for what I have today.

• 38:17Speaker 00

  But it's interesting, and I'm just for, for the listeners, I'm thinking about trauma and tragedy, right? And that, when I asked you, how, how are you so happy, right? And how have you built and how did you give yourself permission? I think it's helpful for people to hear that sometimes it comes from the darkest moments and that you build a new foundation.

• 38:35Dr. Mary Claire Haver?

  I totally did. I'd never thought about it that way. But yeah, I was like, I'm, I'm giving a gift that they weren't given. I'm getting lives years that my brothers never had. What am I going to do with that? And it just becomes so easy to start cutting away the things that don't matter or aren't making me a better person and really putting myself first, taking care of my own needs, and so that I can be a better support to the life that I built.

• 39:04Speaker 00

  I mean, there's a big reframe, right? Like, I think when you, when you, what you're talking about, what you've asked me before is, there's a lot of like victim mentality, like in terms of how do I, how do I not get in my own way? I think one of the things that happens in pessimism, so this is built on the work of Dr. Martin Seligman, positive psychologist. And he said that when we're, when we're bathing in pessimism, we tend to take things personally. He calls them the three Ps, right? And we think that the negative thing is pervasive. It's in all aspects of our life. And we think that it's

• 39:33Dr. Mary Claire Haver?

  I certainly get caught in that trap.

• 39:35Speaker 00

  And we think that it's permanent. And I added a fourth P, which is that all of that makes us passive. So the bad things that are happening in my life are my fault. They're never going to go away. And it sucks all around.

• 39:48Dr. Mary Claire Haver?

  How do we break that cycle? Because I get trapped there and I have a panic attack.

• 39:52Speaker 00

  Yeah. So one thing I say is, I talk about this in the pillar of emotional processing. It's a four step plan. So whether it's a big problem, whether it's a small problem, first identify the trigger. We know time and time again that people that are more granular about the problems in their life that can very specifically pinpoint to the shift in their day. This was the incident that pissed me off. This was the antecedent. This was the trigger. So I call it name it, name the problem, name the antecedent, claim it. Where in the body are you experiencing this? Because for a lot of us, we're holding tension in our jaws, in our shoulders, insomnia in our bellies. So name it, claim it, tame it. So this is where, you know, the actionable items of what helps self soothe you.

• 40:37Speaker 00

  And I think a lot of us as adults, when we were kids, we would suck our thumb, we would cry. What is your self soothing go to technique? Right? For some people, for me, it's like, I call them oasis moments, 60 minute, 60 second meditations. If you can do five minutes, great. But, you know, I had to learn this like on our 36 hour shifts in the hospital in a utility closet, not sexy, not glamorous. Now I call it a little zen den. It's like a pillow on the floor. But where can you just in your car before you get home, don't enter the house before to the chaos of the rest of your life and the rest of your day and your family without giving yourself 60 seconds to do a deep breathing exercise, progressive muscle relaxation. It's like tensing and releasing muscle group by muscle group. So

• 41:22Dr. Mary Claire Haver?

  What's happening in the brain when you do that?

• 41:24Speaker 00

  So you're basically allowing for vagal parasympathetic flow. And there was a book written in the, I think, seventies called the relaxation response. And I feel like there's so many different roads that can help, like basically dampening the sympathetic fight or flight, norepinephrine. That's our bodies are constantly in, in feelings of threat. And I, and I don't know why I can definitely see in the peri penopause phase I'm going through, I'm on edge and I can't even tell you why. I don't know what the threat is, right? There's no bear coming after me, right? Like I'm not in school and I'll sometimes have dreams that I've missed the bus or there's an exam. We carry the certain sense of like, and also surveillance and self surveillance, right? Like We start to internalize this idea. So when people, when we feel like we're being

• 42:08Speaker 00

  watched and people don't realize this, it's something I'm thinking about and writing about now is this concept of open kitchen plan. And then now we have an open plan in our offices, right? So this, this idea that we're going to be productive and it all comes from, it's, it's really funny. It was meant as a prison design where the, the prison guards are watching you and they could be watching you. Maybe they are, maybe they're not. But the idea is that you're going to internalize this surveillance and then you're just going to act and do the right thing because you feel like you're being watched. And I think that's what's happening to a lot of women because of social media, because a lot of us have our brands online. But even if we're meeting up with friends for brunch, oh, what's the cute outfit? What I'm like, so we're on and we're presenting and we're performing and I'm frankly sick of it. And also I think when you get older, like there's, you know, that, that there's a concept

• 42:52Speaker 00

  of the FOMO fear of missing out, but then there's also JOMO, you know, and like the, the joy of missing out. And it's like reclaiming back your time. If you get invited to an event, like I remember one time being on a show, it was with Kelly and Mark, Kelly Ripa. And I remember her, we were talking about friendships and, you know, not saying no to the invitation. And she made a joke. She's like, I love to say no to the invitation. I want to stay home and do nothing. And I remember not quite, and this was a few years ago, and I like, didn't quite get it. And now I'm like, I get it now. I understand when you're so overworked and exposed and talking all the time, all you want to do is just, I don't know, be home in your, like, I don't know about you, but like,

• 43:28Dr. Mary Claire Haver?

  Well, now, I mean, last year was my year of yes. You know, menopause was, I was writing this incredible wave. I was saying yes to every invitation, every talk, every, we started the podcast, like, and then by the end of the year, I was completely burned out. I had gotten multiple back to back viral infections. I had pulled my back with a heavy suitcase and that was taking a long time to heal. I was just exhausted. And I remember waking up here in New York in the hotel at four in the morning and just being like, I can't, I can't do this. And having a come to, come to Jesus with my team of like, I had pushed myself too far. We really need to cut back. And like, 2026 is my year of no. Absolutely not. If it doesn't, you know, if it's not a hell yes, like a hell yes, it's a no for us. And it's been amazing.

• 44:13Speaker 00

  Yes.

• 44:14Dr. Mary Claire Haver?

  I like to stay home.

• 44:15Speaker 00

  There's something so beautiful in reclaiming your time. And I think for me, the through line with this, our conversation is so much about agency. And I love what you said about giving yourself. Permission to not need permission. Right. And it's building that foundation.

• 44:28Dr. Mary Claire Haver?

  My whole career, I've asked someone permission to do anything. May I see this patient? May I ask for a promotion? May I, you know, and, and just being my own boss has been fantastic.

• 44:40Speaker 00

  I love that. You know, the last step of though I said, name it, claim it, tame it, right? And the last step is reframe it, which is how can I look at this? Whether it's finding the silver lining. And sometimes you're not going to be able to reframe, like, and I said, in those cases of something so horrific and tragic has happened. You ask yourself, is this a problem to be solved or a truth to be accepted? So that's really important and not everything, because we talked about toxic positivity. You can't put a positive spin on everything.

• 45:05Dr. Mary Claire Haver?

  No.

• 45:06Speaker 00

  But, you know, I'm just thinking about what you're sharing, and I think everyone will have their version of it. Like, even if they're not, you know, fabulous like you, like doing like, you know, companies and, you know, podcasts and Oprah specials and like all sorts of. But they have their version of, I have, I broke, I have too much. Right. And looking at that moment as the reframe, you can look at it as holy shit, like I'm broken. Or you could say this is an opportunity for me to do an inventory and an audit of what brings me pure joy and pure pleasure. And I feel like that's kind of where I am right now, where I want to keep my focus and my interest very narrow. I want to focus on building muscle.

• 45:42Dr. Mary Claire Haver?

  How much do you think of that as menopause? You know, like your ability, your realization of the need to have to do this.

• 45:49Speaker 00

  Yes.

• 45:50Dr. Mary Claire Haver?

  Is, is tied to what's going on hormonally?

• 45:52Speaker 00

  I think a big part of it, I think, you know, I remember my mom had once said to me that she thought, she, she called it the wisdom of menopause. Because, you know, she is.

• 46:01Dr. Mary Claire Haver?

  Your mom talked about menopause.

• 46:03Speaker 00

  Yeah, believe it or not, but, but.

• 46:04Dr. Mary Claire Haver?

  Was she a doctor too?

• 46:05Speaker 00

  No, she, she was a PhD in special education, but like, nobody talked about menopause, like it was not a thing.

• 46:09Dr. Mary Claire Haver?

  My mother, it was a dark closet she went and hid in.

• 46:12Speaker 00

  Yeah.

• 46:12Dr. Mary Claire Haver?

  You know, and they gave her drugs.

• 46:13Speaker 00

  It was funny because we, when we met, we met at a, well.

• 46:16Dr. Mary Claire Haver?

  Breakfast.

• 46:16Speaker 00

  Yeah. Conference where Oprah was speaking, and I remember watching Oprah with my mom as a kid. And she had some specials, maybe like one or two about how. You know, menopause cracks, you know, my mom had a heart attack and I think at that on the table, she, she had anesthesia and she was not at all one of these people who believes in visions or superstition or anything like that, very like scientific and fact based. But she was like, that surgery changed me. She's like, I came back a different person. And it was, it was at, at menopause, right? Like when women are dismissed, it's not, women don't die of heart disease, women don't get heart disease, this is reflux. So she was minimized and dismissed and had like 90% blockage in her LAD, quadruple bypass, came vegetarian,

• 46:58Speaker 00

  non-smoker, yoga, no like risks that, you know, other than being South Asian. We've later found out that South Asian women have small coronary arteries, but still, so just the typical being dismissed by the medical system. And she said that it, it allowed me, whether it was the heart attack, whether it was menopause, they all happened at the same time, an opportunity to see that I don't have to live by other people's rules, the wisdom, she called it the wisdom of menopause. And, but, and I don't, we didn't talk much more about it, but I just do know that she went through a transition where her eyes were open. You know, she was very hyper educated for her age and time and my father and her very both supported each other. They were advocates with child mental health, with women's rights. She worked with the first and second prime minister of India to create

• 47:43Speaker 00

  this model school that started in her nursery, in her living room, from a nursery school to four acres, 1,500 students over two campuses. And she just said, I always would do what was expected of me, the obedient, dutiful daughter, helping her parents, flying back to India, back and forth to take care of them, us, my dad being an obedient wife, submissive, but at the same time, a very powerful woman. And I saw my parents really support each other. But I do know that at, at the end of the day, she played a very, like a deferential role and almost to her detriment with her health. So it makes me think of all the things of my dad is a superager, he walks five miles a day, Peloton, weights. And my mom could have done things differently, I think, if she had prioritized muscle health, metabolic

• 48:27Speaker 00

  health. So I learned from, from both of them. And I do think that something happens in midlife where you all of a sudden realize. I don't, I'm not immortal. And that sounds so silly, but I think when you're 20 or 30, it's not on your mind.

• 48:40Dr. Mary Claire Haver?

  I'm literally trying to teach my daughter these lessons, daughters, and it's really hard for them to hear it because they're, they're 25 and 22, you know? And hopefully they'll hear it better in their 30s.

• 48:51Speaker 00

  Yeah.

• 48:52Dr. Mary Claire Haver?

  But this mortality thing, I, I'm seeing that with my patients. So they are, they come in for the fires of menopause, right? Like the hot flashes, da, da, da, da, you know? We give them back their resilience. And then they're like, keep me out of a nursing home. I don't want to be a burden on my children.

• 49:08Speaker 00

  Mm hmm.

• 49:08Dr. Mary Claire Haver?

  I want to live independently as long as possible because we're watching our, the way our parents are aging in general, not all of course, but like the women and tend to have a very poor quality of life for those last 10 years.

• 49:22Speaker 00

  Totally.

• 49:22Dr. Mary Claire Haver?

  Versus the men. And I'm like, that's systemic. That is not a, that doesn't have to happen. And so I love being able to counsel patients around that. And like you were saying, like the shift of, oh, I, I should probably be looking at my muscle mass. What is my bone density? Like, what is my cholesterol? What's my LP little A? You know, what are my risk factors here? Because medically, we were, women don't have heart attacks. Women, da, da, da. Turns out the number one killer of women is heart disease.

• 49:46Speaker 00

  Yes. And that, that feeling of like, I think midlife, what is my purpose now? I'm seeing a lot of women, uh, friends who are early 50s and they are living their best life. Like, I love that. I love that. And so I feel like, you know, you know, what's really interesting? Your, um, viewpoint on aging determines your lifespan.

• 50:07Dr. Mary Claire Haver?

  What do you mean by that?

• 50:07Speaker 00

  So people who have a positive view of aging on average are living five to seven years longer. And I'm going to check the stats and get back to you on that. But people, when they looked at them, like, do you think that aging is a good thing? As opposed to, are you scared of it? Are you afraid that you're going to be a shriveled old person? People who say, I'm looking forward to it. So even just like, this is where the optimism comes in, is having, optimism really is just positive life expectation, right? That I do believe that the best outcome is going to be possible.

• 50:44Dr. Mary Claire Haver?

  What about the woman who goes to her doctor? And they say, you're depressed, you're anxious. Okay, here's your medication, here's your SSRI, which is what I was trained to do, right? I didn't know anything about therapy or, you know, not a psychiatrist. She gets her medication and it's working okay. And then it stops working. And that happens a lot in perimenopause. You know, you develop a mental health issue, you become medicated and then the hormone changes. What should, you know, they go back to the doctor and they're like, add a second medication or increase the dose. But should she be doing something different? Like, what can she do for herself?

• 51:22Speaker 00

  So first thing is, when a patient comes to see me, I always ask them to get labs, or if they have labs, from their primary care doctor. And what I'm looking at is vitamin D level, which all of us are deficient at living in the northern hemisphere, even if we are darker.

• 51:35Dr. Mary Claire Haver?

  Eighty percent of my patients.

• 51:36Speaker 00

  Yep. And I have patients who have vitamin D's in like the twenties or thirties, or that may be normal, but it's low vitamin B12. So many of my patients are low in vitamin B12, or it might be right on the cusp. And their doctors will be like, it's fine, it's normal. But we know that neuropsychiatric symptoms, you can get jitteriness, anxiety, insomnia, depression, low motivation, all from even low normal, right? So if there's any room, you know, and pushing your primary care doctor, and sometimes I'll have to get on the phone to say, listen, I understand it's at the cusp, but I do think, would it be worth it? Whether it's oral supplementation or if they're able to get monthly injections, I do see a big difference with the jitteriness and the mood. And I think for a lot of women, that, those are their symptoms.

• 52:15Dr. Mary Claire Haver?

  Okay, so vitamin D and B12.

• 52:16Speaker 00

  B12, thyroid. So TSH, T3, T4, and also CBC. A lot of women have anemia and they may have low ferritin for any number of reasons. And like even diabetes, chronic diabetes, cholesterol, a lot of the medications that they're on, so beta blockers can cause depression. So just getting a full profile of the labs, the medications that they're on, side effects of it, anything like people who have untreated or undiagnosed ADHD. I see a lot of women midlife for the first time or realizing, oh, that's what that was my entire life. I thought. It was brain fog for whatever. And sometimes a low dose stimulant could be helpful. Sometimes a low dose stimulant could be making them more anxious. So really just getting a full sense.

• 52:58Speaker 00

  So I do think that getting the labs check plus asking, you know, a lot of times people are only getting medications from a primary care doctor, but they're not also in therapy.

• 53:07Dr. Mary Claire Haver?

  Okay.

• 53:07Speaker 00

  And so therapy to me, even if it is six weeks, eight weeks, a short course, we find that even one brief psychotherapy intervention can be really helpful. But obviously six to eight weeks of cognitive behavioral therapy. And I went through this myself and I found this so helpful when I was in training. We were told, oh, everybody should go to therapy. And I'm like, okay, with what time and what, what money? I was working at five different hospitals in New York City and a hundred hours a week. And therapy in Manhattan, nobody takes insurance, super expensive, right? So it wasn't until I had my own mini breakdown of sorts that I ended up seeing a therapist.

• 53:42Dr. Mary Claire Haver?

  Same.

• 53:42Speaker 00

  And it was a professor who had given a talk and I had this vision in my head of therapy is Freudian. You have to be on a couch the half the time the older male therapists are falling asleep on you and not listening and not paying attention and you're not.

• 53:54Dr. Mary Claire Haver?

  And you're a psychiatrist.

• 53:55Speaker 00

  Yes.

• 53:55Dr. Mary Claire Haver?

  And this is what you thought.

• 53:56Speaker 00

  Yes. And because that was a lot of like the psychoanalytically trained and nothing against it. There's some, there are different modalities of therapy and to each their own. And you have to go to what, what speaks to you. But we ended up having a lecture like I, this was like one of the lowest points in my life. My mom was diagnosed with stage three breast cancer because of her heart disease. Nobody wanted to give her chemo. They said she's going to put her on chemo toxicity and give her heart failure. So I was like, oh my God, she's going to die. Breast cancer is treatable, except she can't get any of the treatments. And I'm already working a hundred hours a week and then I'm thinking, oh my God, she's going to die. Right. And I'm going to five different doctors and trying to find her, someone that's going to treat her. And in the midst of all of this, my legs give out. I can't walk like, and there's nobody who can explain. I went to see the best neurologist. They're doing EMGs. They're like, you're totally fine. And I was like, but I'm not fine, right? And that felt like just dismissive, like go figure it out.

• 54:40Speaker 00

  And I was like, how exactly am I supposed to be figuring it out, right? I'm not sleeping at all and I was doing very well in residency. And then we had this professor give us a talk on cognitive behavioral therapy. And he's like, it's short term, it's time limited, it's very action oriented, problem, solution focused. And eight to 10 weeks, it changes your life. And I literally was like, sign me up. I'm like, give me a referral today. And it did change my life because it put me in the driver's seat as opposed to bad things happening. I'm always, I feel one step ahead, right? Doesn't mean that I live life, you know, carefree, not at all. But what it taught me was, number one, cognitive restructuring, which is really important. What we did was naming the antecedent and then keep

• 55:21Dr. Mary Claire Haver?

  What's an antecedent?

• 55:22Speaker 00

  So like the trigger, like, so in my case, it's, oh, my God, I got this, you know, diagnosis on my mom and she's gonna die, right? So that, all of a sudden, that's your, your thought, the antecedent, the thought is, she's gonna die, I'm going to fall apart, I want her to meet my, you know, walk me down the aisle and see her grandkids and, you know, I'm in my twenties, so I'm not married yet, and all of these future projections that I'm catastrophizing. And then you're writing down what are all the things that you're doing, which is, I'm jumping to conclusions that she's not gonna find a doctor, I'm fortune telling, I'm writing, I'm projecting all of my worries and fears. I mean, the list just could go on of, and these are things that we all do. There's like eighteen or nineteen, what we call cognitive distortions, mind reading, we assume we know what someone else is thinking, jumping to conclusions, right,

• 56:05Speaker 00

  fortune telling, dismissing the positives. And so that was a big one, right? When we, it's called negative filtering, you're, you're looking at everything through this one negative lens. And you're minimizing, or what we call discounting the positives, which is, I am a doctor, I am connected, I know a lot of people, I can get her help, right? So in those moments, we overestimate the magnitude of our problems, she's gonna die, versus underestimating the agency and the control and the power we did have, which is eventually problem solving, okay, this is where we, we switch from unproductive worry. So when you're talking about the patient that comes in, what else can we give her? Tools. We wanna give her tools. It's not just sending her with an S S R I prescription, which is very helpful. I do think that antidepressants, when you do a thorough behavioral health assessment,

• 56:49Speaker 00

  is this person depressed? It's not hormonal, okay, can you send them, can you get them a referral to somebody as wise as you are, right, in their area? Can we rule out labs, but also, let's get them skills so that they feel agency again? Because even if it is hormonal, even if they are dealing with vitamin deficiencies, how can we strengthen? And beef up their own internal systems so that they can respond to the challenge ahead. So the unproductive worry would be somebody spiraling and being like, I can't do anything. Five people said they can't help her. She's doomed, I'm doomed, we're fucked, right? Like, sorry. Or moving from unproductive worry, which is like your car stuck in the mud, wheels are spinning, there's no translation, rocking chair, there's movement, but there's no acceleration.

• 57:33Speaker 00

  And then productive worry is, now what? Who am I going to call? And eventually, we found a doctor who, a lovely oncologist, who's like, I'm going to help her, I'm going to reduce the dose instead of this treatment, I'm going to give her like the smallest amount and let's see, and I'm going to monitor her very, very carefully. So the problem is that most people give up before they get to the solution because they end up getting paralyzed by it. So I would say if I'm working with someone, I want to give them tools because the tools that you get in therapy, they stay with you for life. The medications, once you're off them, you're right back to where you began. So they have an important role in that for a lot of people who are like, I'm so depressed, I can't get out of bed. I'm so depressed, I don't even want to see you, doctor, in your office. I don't, I don't even want to get on Zoom to talk to you.

• 58:16Speaker 00

  So I say that kind of person who is not feeling a sense of meaning in their life, they have lost a sense of purpose, they have lost joy and pleasure in the things that they once used to love, that's called anhedonia. That, to me, is the hallmark of depression. If you told me, I love swimming, I love golfing, I love playing mahjong, I love traveling with my husband, I love going out to dinner, I love getting dressed up, I don't do any of those things anymore. I can just tell you right there, that's depression, right? Like, and you need skills, and this is called putting the cart before the horse, where we know, like, if, when a person is depressed, they don't want to go to a party, they don't want to see a friend. But we do know that once they see that friend, that it is so rewarding for them that it is like, it's a, it's a form of an antidepressant.

• 59:00Speaker 00

  So I talk about this in like the four M's of mental health, but Putting the cart before the horse, pushing yourself to do something before you feel ready, populating your calendar with activities that bring you pleasure and meaning and joy. So looking at your schedule for the week and putting those fun things in there. I think fun has always been the thing that I put last, always.

• 59:20Dr. Mary Claire Haver?

  Always.

• 59:21Speaker 00

  Like family, friends, health, patients, work probably is first and then everything else, right? But scheduling in joy as if your life depends on it, because it does.

• 59:30Dr. Mary Claire Haver?

  Talk to me about the four Ms.

• 59:32Speaker 00

  Yeah. So if I had to tell someone in less than five minutes, I was in a situation where it was the height of the pandemic, it was April 2020, and New York City had reached its peak death toll. And I get a call that Global Citizen is doing a program and it's going to be a one night live stream with all these famous Elton John and, you know, I don't know, Oprah and all sorts of J Lo performing like a benefit concert. And I was like, great, I'll be watching. And they're like, no, we, we want you on the show. And I was like, I don't sing and I don't dance and nobody want to see that, right? Rolling Stones, like, you know, like one of those big performance benefits. And they're like, no, we want you to talk about mental health. And I was like, oh, like what, what specifically? And they're like, we want you to give people tools and calm them down and like, you know,

• 1:00:16Speaker 00

  the whole world is scared and broken right now. And I was like, great, how long do we have, like an hour? And they're like, no, you have 59 seconds. And I just started laughing. I was like, I'm supposed to give you hope and motivation and a toolkit in 59 seconds? So I called my dad psychiatrist and I was like, dad, what, what do you talk about in 59 seconds? He's like, it's okay, it only takes a minute to save somebody's life. And then he hangs up. And I was like, I was like, Yoda, where is the wisdom? I need some practical, tangible tips for my own anxiety here, right? But then I thought about what if I had to prescribe somebody in less than a minute, something that could, that is evidence based, that is science backed, that could save their life, that I prescribe to my patients, that I do myself, that I see in my dad, this super

• 1:00:58Speaker 00

  healthy, super happy, optimistic, super ageer, what are we doing every day? And I remember that years ago, when we had those old school prescription pads. I used to write on them for my patients a prescription. Yeah. And they would be like, they would laugh at me. They were like, I was hoping you would fill my lorazepam, my benzodiazepine, where is my medication? And I would say, this is your medication. And I would write four things, right? And I was like, okay, I need to make it simpler. So I, for the purposes of this talk, I said, okay, we're going to talk movement, mindfulness, meaningful engagement and mastery. And there's so many more things, sleep, diet. I don't want to say that these are the only four habits, but these are the four habits that in and of themselves are good mental health. But then they beget any kind of new project that you want to start.

• 1:01:43Speaker 00

  Th- this will help you do that. So when it comes to mastery, I say, you don't have to be a master at something, but you have to do something that helps put your brain in a flow state. And in that flow state, it's this, your norepinephrine goes up, which helps you super focused, super concentrated. Uh, it improves your mood and it's this delicate balance between an activity being challenging enough to sustain singular focus and concentration. And the beauty of that is it shuts out the default mode network. That is the part of the brain that is ruminating and you're not good enough and self sabotage. So that is how you drown out those negative voices is focus on something 10 to 15 minutes a day and then do more of it. That really helps you be in the zone. Pottery, golfing, yoga, whatever it might be, something that you want to get better at.

• 1:02:25Speaker 00

  It's challenging enough to keep you focused, but not enough where you get frustrated. So you don't want to get bored and you don't want to get frustrated. So it's this perfect, like, it's like a U-shaped curve, like, I'm sorry, inverted U shape, where this, at the peak of the height of this inverted U shape is perfect. You're, it's, it's. Zen. Yeah, you're in the moment. So that's mastery. Take up something and, you know, I, I do talks to a lot, with a lot of young people, like I'll go to high schools and they'll have a, you know, presentation about mental health and practical optimism. One of the things I'm hearing a lot is teens don't have any time to do anything fun for themselves. They say, everything I'm doing. Overscheduled. Yeah, is for this college purposes. So doing something that has no benefit to social media, you're not showing off to anyone, it is just for yourself. If you want to post your whatever pie that you made, if that's your thing, do it later.

• 1:03:09Speaker 00

  But that's not why you're doing it. You're doing it for yourself for no, for no other reason, just to get better at something. Language is learning language, dancing. We know that there's so much health benefits and neuroplasticity with dancing and living longer. So mastery, movement, we can, that's a whole other thing, but 10 minutes, lower the entry barrier. Keep your sneakers next to your bed. Keep your gym clothes next to your back. Keep that water bottle filled. I have a separate gym bag where I have a separate set of keys, just so I don't forget, like, any little thing. A separate set of AirPods, whatever it is.

• 1:03:38Dr. Mary Claire Haver?

  That will sabotage you.

• 1:03:39Speaker 00

  Yeah. So 10 minutes, you have weights and a yoga mat by your bed, strength training. We know you've talked a lot about that. Please invest in your muscle health. That is the organ of longevity.

• 1:03:50Dr. Mary Claire Haver?

  Mm-hmm.

• 1:03:50Speaker 00

  And meaningful engagement. This is by far my favorite pillar. I love talking to people, as you can tell, and connecting with people on a deep and meaningful level. But one of the things that gets scary for a lot of people is I don't have time, right? And I want to connect, but I don't have time. I think of, there's micro connections where you can connect with somebody. You're standing, talking to the barista, someone walking a dog, a neighbor, a bus driver, a doorman. These are micro connections. They don't have to be your best friends. You don't have to ever see them again. But think about, when you move throughout your day, can you schedule a 10 or 15 minute buffer in your day, so that you allow yourself to have these small moments. You're online, you're talking to someone. So anything from micro connections, which are small, built-in moments of connections,

• 1:04:35Speaker 00

  with random strangers, to activity partners. Don't minimize the person you get to go to yoga with, right? Or that you see them every day or at a class. Like, that has value overall. It doesn't have to be the deep and meaningful conversations. But that is really important. Having at least one or two authentic places in your life where the mask comes off, that mask of performance.

• 1:04:57Dr. Mary Claire Haver?

  Mm-hmm.

• 1:04:58Speaker 00

  We don't have to impress this person. And I call this, this concept, one of the things that I'm thinking about a lot is how we are expected to perform all the time and be visible all the time. These are areas where you can be held. And I say, we're, as a society, we're seen, but we're not held. We don't have areas and protected spaces and places where we're not expected to be impressive, or on, or have our hair and makeup done. I don't know about you, but like

• 1:05:25Dr. Mary Claire Haver?

  Well, my life has gotten more like that.

• 1:05:26Speaker 00

  Yeah.

• 1:05:27Dr. Mary Claire Haver?

  In this, this new iteration of Mary Claire is I'm performing a lot more than I used to.

• 1:05:33Speaker 00

  Yes, and that's exhausting.

• 1:05:35Dr. Mary Claire Haver?

  Mm hmm.

• 1:05:35Speaker 00

  It is exhausting and it takes up so much of like that executive functioning in the prefrontal cortex of having to be on. I was telling my husband, I'm like, you and my dad last night, I was like, I, I came from a TV interview and I was saying, you don't understand how hard it is to be a woman when you have so much knowledge and information to give. It's not the depth. The one, the, the number one question I get asked is what was your lipstick color? I was like, I'm talking about suicide. Why are you looking at my lipstick?

• 1:06:00Dr. Mary Claire Haver?

  Where'd you get your pants?

• 1:06:01Speaker 00

  Yeah, exactly.

• 1:06:02Dr. Mary Claire Haver?

  Yeah.

• 1:06:02Speaker 00

  So meaningful engagement is be vulnerable, be authentic. Schedule an eight minute phone call, you know, like this was something that came from the New York Times and I loved this idea of like, they had like a friend challenge and I was interviewed for an energy challenge and then someone else did a friend challenge that week in the January 2024. And I loved the person who had, who had offered this advice, which was in eight minutes, just pick up a call. You're on your way home, you're on your commute, if it's safe enough, but that's how you create connection. You're stuck at the airport, call a friend. So be very intentional about scheduling those connections in person as much as possible. And go to a place where you can drop the mask and the hat, but don't forget activity partners and microconnections because those are like the, the social snacking as well. And then the mindfulness, find your Zen Den, create a Zen Den in your home.

• 1:06:45Speaker 00

  It could be a pillow and a blanket on the floor. It could be a yoga mat, but it's a place that you designate in your home, in your life. It could be in your car, but 60 seconds of deep breathing, two to three times a day. It just creates these islands of this is my space. Reclaiming space and reconnecting to your breath. And it also is lowering your heart rate and lowering the cortisol, lowering the norepinephrine that is constantly in the fight or flight mode.

• 1:07:12Dr. Mary Claire Haver?

  Welcome back to another Midi Pause. I'm Dr. Mary Claire Haver, host of UnPaused. Today, we're talking about something that deserves far more open, honest conversation. Sex and menopause. Sex is a cornerstone of intimacy and connection. But as life changes through stress, childbirth, aging, and menopause, so does our relationship with it. Somewhere along the way, there's been this narrative that menopause signals the end of a woman's sexuality. And that couldn't be further from the truth. What it can signal, though, is change. Hormones shift, and that can come with things like lower libido, discomfort, or just feeling off in your own body.

• 1:07:55Dr. Mary Claire Haver?

  Most clinicians were never taught how to evaluate libido, arousal, orgasm, or sexual pain. OB-GYN training focused on pregnancy, surgery, and cancer screening. Sexual medicine was not part of the curriculum, and still largely is not. So when women are dismissed, redirected to therapy alone, or told everything looked normal, it was not because their symptoms were imaginary. It was because the system failed to train clinicians to recognize and treat sexual dysfunction. Women internalized that failure. They assumed it was just aging, just stress, just marriage, just something to endure quietly. It is not.

• 1:08:40Dr. Mary Claire Haver?

  And here's what makes this even more challenging. So many women are experiencing these changes, yet too few are offered real education, validation, or solutions. That's where platforms like Midi Health come in. Midi connects women with clinicians who specialize in midlife health, including menopause and sexual wellness. Instead of having symptoms brushed off or feeling dismissed, women can access personalized, science-backed care, whether that include hormone therapy, non-hormonal options, or simply working with someone who truly listens. Midi Health is built specifically to address the gaps in midlife care. It brings together clinicians with expertise

• 1:09:24Dr. Mary Claire Haver?

  in menopause and related health concerns, offering virtual care that is accessible, evidence-based, and centered on real patient experiences. Because this is not just about sex. It's about quality of life. It's about confidence, connection, and feeling at home in your body. If you are struggling with low libido, painful sex, or other concerns, know that help is available. Explore treatment options. And most importantly, give yourself grace. Intimacy is about more than just sex. It is about connection, pleasure, and feeling alive in your own skin. Menopause is not the end of anything. It is a transition. And with the right support,

• 1:10:09Dr. Mary Claire Haver?

  it can be a really empowering one. Go to joinmidi.com. Join M-I-D-I dot com and connect with one of their clinicians today.

• 1:10:23Dr. Mary Claire Haver?

  A lot of my patients are really struggling with sleep. And you know, if it's hot flashes, and especially the wake-ups. You know, a lot of them, you know, if they're not lifelong anxiety and struggling to go to sleep, you know, hormones go do a lot for those patients. But what I'm seeing even with adequate hormone therapy is these middle-of-the-night wake-ups. You know, and we look, she have to get up to pee? And we talk about restricting fluids and stuff, or if that's being caused by an overactive bladder, you know, we can medicate that. But so everything's perfect. And she's not anxious when she goes to bed. She falls right asleep, but she's waking up. And this doesn't get better post-menopause. It starts in perimenopause and then kind of keeps going. What do you think is happening? Like, if she wakes up and can't,

• 1:11:07Dr. Mary Claire Haver?

  you know, there's an anxiety loop that starts.

• 1:11:09Speaker 00

  Yes.

• 1:11:09Dr. Mary Claire Haver?

  You know?

• 1:11:10Speaker 00

  Yes.

• 1:11:10Dr. Mary Claire Haver?

  Like, how can we help her?

• 1:11:12Speaker 00

  So first, just acknowledge that it is normal that the 3:00 AM wake-up is happening for any number of reasons. Cortisol is trying to get in action again in anticipation of the morning. Melatonin in this stage of our lives for all people in general, but women especially, is going down. So it's expected that you will wake up. But if you don't tie a negative association with it that I am doomed, because there's always anxiety, but then there's anxiety about the anxiety or the anticipatory anxiety. We call this metacognition, thoughts about your thoughts. Don't label it as anything more. This happens to me a lot when I'll wake up and then I'm aware of the time. But here's the thing, is don't be aware of the time. I think the biggest thing that we do is we first look at our...

• 1:11:52Dr. Mary Claire Haver?

  3:17.

• 1:11:53Speaker 00

  Yeah.

• 1:11:55Speaker 00

  That's the time, like, it's like the witching hour, you know? And so we look at the time, we're aware of it, but where are we looking at the time? We're looking at it on our phone because most of us don't have.

• 1:12:04Dr. Mary Claire Haver?

  A clock radio anymore.

• 1:12:05Speaker 00

  Yeah, and that's a problem because then you say to yourself, oh, I'm just gonna scroll. I'm just gonna check my messages. Did somebody email me or call me or whatever? And we do it as a form of distraction or we think that we're catching up because we always want to be in the know what's happening in the world at this moment. And there are so many problems happening right there. Number one, you're getting activated just by knowing, by simply being aware of the time. That's already activated. Then you have the blue light that's happening. Then you have the messages and the unfinished business loop. So that's really big for a lot of women. Our brains, I think it's a normal thing, but I think I see this a lot in high achievers. The desire to close the loop. I don't know about you, but I don't like unfinished business. I don't like if I have emails or if there are messages or people that are waiting.

• 1:12:49Speaker 00

  That sense of urgency of putting other people's needs, right? That feels uncomfortable to me because I feel like I need to close the loop on that. So do not introduce other people's problems into your own life. Do not introduce them, do not invite them when you wake up at 3 a.m. So when you get out of bed, the whole thing with CBT insomnia is supposed to be the gold standard is that if after 20 minutes you're not able to fall back asleep, you're supposed to get out of bed. And you're supposed to do something extremely passive and extremely boring. So have a wonderful history book that if you're assuming you're not interested. I find history interesting, but if you don't, find some subject that is either soothing or passive or boring or calming. For some people, maybe folding laundry, right?

• 1:13:33Speaker 00

  But it should be in a dark, cool area. Get out into the living room, sit for 20 minutes, but do not look at your phone. You will not be going back to sleep, I guarantee you. It'll be two hours before you'll realize it.

• 1:13:43Dr. Mary Claire Haver?

  Someone on social media, this is a topic of conversation quite a bit on my social. And this woman commented one time and it just made so much sense to me. She said, like, just imagine you're a cave person and you're just gonna throw another log on the fire. Like, it's your turn. Like, you woke up, you're gonna go take care of, you know, and you're meant to do this and you're. It's part of your life and you're gonna throw the log on the fire and then go back to bed. Check on, check on, you know, you're checking on the other cave people. Everybody's okay. Everybody's asleep. And then you go lay back down, you know, and reframing it as, you know, I was anxious about being anxious. You know, I was like, oh, my God, I'm up, I'm up. I can't believe I'm up again and I have to do today. And like, oh, it's my ancestor waking up to go take care of the fire that needs to keep going all night. It refreeze to death and it's her turn.

• 1:14:28Speaker 00

  Yes, yes. I love that. Normalizing it totally.

• 1:14:31Dr. Mary Claire Haver?

  And I'll just go back to bed and it'll be fine.

• 1:14:33Speaker 00

  Yes, it'll be fine. I love the, because you're reframing it and I love the simplicity is it'll be fine. Because the minute you say to yourself, I've done this before, right? Like I have, I've been able to fall asleep before. And I have, I have functioned the next day on little sleep because that's the biggest thing I think people are thinking. How am I going to get through the next day? And I would say, keep your routine wake time, even if you had trouble falling back asleep, because I think a couple of things end up happening. Sometimes if a person has the luxury of sleeping in, if they didn't sleep well, they will. And then that destroys their sleep architecture for the next day.

• 1:15:04Dr. Mary Claire Haver?

  Circadian rhythm.

• 1:15:05Speaker 00

  And then limiting the number of naps. If you, if you still keep to that, whatever wake time you have, the next night you are passing out and most likely not waking up at 3 a.m.

• 1:15:14Dr. Mary Claire Haver?

  So I'm finding a lot of women in midlife are struggling with loneliness. The, the ties that bound them while their kids were younger, the friend groups, the families. People start going through divorce and, you know, those kind of friendships are breaking up. Kids are growing up, moving away and the things that kind of kept you together in your friend groups. And my husband and I are seeing this, you know, right now, and the relationships we kind of built when the kids were younger. Are now, you know, and I, I've found myself a little bit lonely sometimes and definitely my patients are, are seeing it. Can you talk about that?

• 1:15:46Speaker 00

  Yes. So, you know, this is kind of peak loneliness when we would expect it. Because you don't have those built in layers, like, so look at those opportunities. Where's the low hanging fruit? So that's the first thing I would say, right? Like if you're in a city, like if you're traveling a lot, to be intentional, like I have, I have a friend who does a lot of speaking all around the world. And she has her lists of who is living in every city and she tries to make it a point to say, I'm here. And I think letting people Know very clearly what your limitations are and saying, I only, I'm so sorry, but I only have time for a 30 minute catch up, you know? And, and I think we create so much extra work for ourselves to be like, it needs to be a three hour dinner catch up.

• 1:16:28Speaker 00

  So one thing that I really loved is this idea of catch up culture, it's not good for us. Catch up culture says, let's meet once a year, twice a year, and we'll sit down for four hours and you'll tell me everything and word vomit and I'll word vomit on you and then we won't see each other for the next year. Instead, Bill's like, kids have parallel play, right? So I have to do an errand, would you mind coming with me, right? Like, I've got to go to the post office, it'll be our time to, to catch up. So build in opportunities where you can do shared activity together or do nothing together, right? So like, why do we have to get dressed up to go to brunch and make it this whole big thing? Come for a walk every, routinize, come for a walk 20 minutes with me every Sunday, right? Like, so make these kind of standing things. If you have one Sunday dinner a month that you can say, I'm going to host, or we're going to meet at a restaurant, to put things on the calendar in advance, planning trips, if

• 1:17:13Speaker 00

  you're in that like phase of life where you're lucky enough to be able to afford and have the health, we have a fan, we have like a standing ski trip that we take, like we have a couple of standing, like one is like a couples trip that just, you know, no, no kids. One is like a family ski trip with a bunch of other families. So if you can, and we have friends that are like crazy, they'll be planning 12 months in advance and we're like, okay, that's too far, let's do six months. So I, I think the number one thing is recognizing that you're lonely. Some people are biologically hardwired to be lonely. That default mode network that beats yourself up, it also has a tendency to say, you know, I feel like there's something wrong, but don't beat yourself up. Loneliness is like a biological drive, it's acute, just the way hunger is. It's a signal that says, I am lacking in something that is nutritional and that is

• 1:17:57Speaker 00

  required for my sustenance, and that is human interaction. So planning it in the calendar as much as possible and, and knowing that it's not going to, it's, it's not going to drop out of the ceiling into your lap. So if I'm traveling and just like, who do I know in this city? Who can I tell them in advance? I'm, let's keep the plans loose. If I find myself having a 30 minute right before I go into, to a talk, do you mind? And most people are so happy that they'll, you'll think it's weird, like I'm getting my makeup done, can you sit next to me? They'll be like, Why would I do that? Don't think about that. I would say most people would be so happy to see you. They'd be like, sure. What do you want me to do? Where do you want me to come?

• 1:18:29Dr. Mary Claire Haver?

  Before we wrap up, the sandwich generation you mentioned a couple of times, but I really think it's hitting us really hard and this is seems to be unique to this generation. What would be your best advice for someone who is absolutely trapped between parents who won't listen? And children who won't listen? Cause you know best.

• 1:18:50Speaker 00

  Yeah, that's the best way to put it. Yep. Oh my God, it's so hard. It's like caring for the caregiver, recognizing that you are a caregiver. I think that people have this vision of caregiver. Caregiver means I'm glued to my 90 year old mother's bed day and night and, you know, changing diapers type or pans or adult, whatever. That's not what caregiving necessarily looks like. It's different for everyone and recognizing that you're in that phase of life where you also get to be a human being. I think the biggest thing and the hardest thing for a lot of women is they hear me saying, so Dr. Baum, you're saying me first? I'm not saying that. I'm saying me too. Just you, you get to pull up a chair. You get to eat at the table that you're serving other people at, right? Like that metaphor of you're so busy providing.

• 1:19:31Speaker 00

  And I'm saying reclaim your own joy and say to yourself, what would it mean if I didn't visit my mom four times this month? What would it look like if I visited her three times? What if I took back one of those times and went to an exercise class? And met up with a friend for lunch or for coffee. I think the guilt is kind of the underneath underlying that I should be. There's this idea of shoulding on ourselves, like something shoulding, right? Like I should, those should statements need to change to, I can, I will, I may, right? Allow yourself variations on that theme of what is reclaiming my own joy, my own time, my own rest look like? And one thing I would say is if you do have siblings, a lot of times people, this, this idea of like weaponized incompetence, it's not just our partners, right? It's also sometimes our siblings.

• 1:20:14Dr. Mary Claire Haver?

  Oh gosh, yes.

• 1:20:14Speaker 00

  And to say, I'm not asking you for help. Let us put down in writing what each person is capable of doing and let's split the load. What are you good at? Are you good at finances? Are you good at looking at referrals from, you know, for, for the parents to suggest? Doctors, you know, can you go to some of the appointments? So I think like looking at big picture and anticipating these end of life conversations that are so hard to have, like talking to your parent, elderly parents, like let's talk. Have you, do you have money put aside? Cause that's a big thing that financial drain.

• 1:20:44Dr. Mary Claire Haver?

  The frustration I'm seeing with our friends and my patients is the parents are refusing to have the conversation. And then there's a lot of catastrophizing on the child's part in that when shit hits the fan, they have to drop everything to go tend, you know, and it negatively affects their life.

• 1:21:00Speaker 00

  Yes. And I, I love and I have so much admiration for people when they're, when they're in their 50s and 60s and they're downsizing and they're like, I don't want my child and they're getting rid of the stuff.

• 1:21:09Dr. Mary Claire Haver?

  My husband and I talk about this all the time. Like, we are going to make this so easy for them.

• 1:21:13Speaker 00

  I love that. Yeah. Anything that you can, whether it's like talking about even getting like long-term care, even renewing, like every year my dad will say, this is my long-term care insurance. This is my Medicare card. I want you to have this. This is who to call. These are my, like where the bank is, the bank account, like giving somebody step-by-step instructions of what to do because in that moment, they're, they're grieving. When your child is losing their parent, you know, the parent is like, I'm not going to be here. Not my problem. And I'm like, no, you don't get to do that. And also, like I do this a lot with my patients where they will tell me about their aging parents and I'll be like, get your parents this vest, you know, this exercise vest, get them dumbbells, help them invest, get them physical therapy, get a prescription for being deconditioned and get them head to toe,

• 1:21:57Speaker 00

  like training, like muscle mass training, resistance, but anything you can do to say, listen, I'm sorry, and have very clear conversations. Who do you think is going to take care of you? Like, let's say your parent is healthy enough to maybe move closer to you or to downsize or whatever. Just say, listen, you live across the country. I just want to understand what was your vision? Where did you want to go? Who's, would you have someone living in your home? Like, were you expecting me to move back home? Like, it's so uncomfortable because I think there's all these implicit, not explicit expectations.

• 1:22:24Dr. Mary Claire Haver?

  Right.

• 1:22:24Speaker 00

  And it's not sexy. It's not glamorous. Parents want to think that, oh, my parents, my kids will come, but they have their own lives. So what are you doing to earmark money, care, insurance, end of life plans, advanced directives, healthcare proxy? What are your goals? Do you want burial? Do you want cremation? Do you want to be on a ventilator, feeding tubes? Like, all of it. Like schedule appointments with your parents and then distribute amongst siblings, aunts, uncles. And I think it's really important that our parents have community. Like I always ask my dad, like often he'll stay with me, like my mom passed. So, but he has a really rich and robust friend network. All the friends that he went to med school with, they meet, they travel, he has neighbors. He goes out of his way to do things for other people. And they're 10 times like able to reciprocate to him.

• 1:23:07Speaker 00

  So I think a lot of people become like old curmudgeons and they're just like.

• 1:23:10Dr. Mary Claire Haver?

  Well, I, yeah, you know, I've watched the, their social network get smaller and smaller and smaller.

• 1:23:16Speaker 00

  Yeah.

• 1:23:16Dr. Mary Claire Haver?

  You know, and my mother lost, once my dad died and three of her kids died, she just never left the house, really, other than to go to the doctor. And then was depending on all of us to like, you know, one of my brothers lived with her. But, you know, it doesn't have to be like that.

• 1:23:30Speaker 00

  Yes.

• 1:23:31Dr. Mary Claire Haver?

  And so, and I, I can see the beginning of her loss of independence. And she's got dementia and has fractured multiple bones. Hasn't been walked on her own in over a year was when she isolated herself.

• 1:23:44Speaker 00

  And often there's cognitive decline and like with the dementia, you know, it's hard to be, you know, I'm just thinking of prevention to me. It's, it's like that whole saying of like an ounce of prevention worth a pound of gold. That anything you can do, like I'm thinking in my mom, like microvascular changes, right? Like she had cardiovascular disease and we think of this as being limited to the heart, but we don't realize the same blood vessels go down to your toes, go to your head. So later on, I realized while there was no stroke, but micro infarcts, microvascular dementia, not a lot, not a lot of people think about or know about. So they have more personality changes that are subtle, that look like depression, that look like you're becoming difficult, you look like you have OCD, you've become more controlling, more rigid, more homebound, bedbound. And, you know, being that she was such a like force of nature, personality wise,

• 1:24:29Speaker 00

  nobody could ever argue with her. So when she started shrinking and becoming isolated, we're like, okay, well, this is just who she is. She doesn't want to go out, she doesn't want to talk to people. And I don't know what we could have done other than now knowing in hindsight that cardiovascular disease is also affects the brain. It changes you, it isolates you, makes you depressed. And anything that you can do to get people when they're healthier to get plugged into volunteering.

• 1:24:52Dr. Mary Claire Haver?

  Prevention.

• 1:24:53Speaker 00

  Yeah. And I remember when my mom retired, her cardiologist said to her, are you sure you want to do this? He's like, the people who remain at work after the heart attack are the ones that are the healthiest because you're going to become isolated. She's like, no, no, no, I'm going to India. I'm helping my grandparents. We lived there and she did take care, good care of them. But this idea of you need to have your own purpose. So I feel like midlife, finding a new purpose. If, if it's not for your kids and if it's not for your career, I don't care if your business is profitable or not. If you can afford it, come up with something to do, to put your energy, because you are your sharpest and your smartest. You have more agency, you have more capacity, more capability at this stage of your life.

• 1:25:34Speaker 00

  You are a wealth and treasure of resources. So don't let society make you feel invisible or less than. Like, I really do feel like this is our best years are still ahead.

• 1:25:44Dr. Mary Claire Haver?

  Yeah.

• 1:25:45Speaker 00

  So I please, I tell people, I understand you might be empty nesters. Find yourself a hobby or a job that will keep you busy out of the house.

• 1:25:51Dr. Mary Claire Haver?

  Out of the house.

• 1:25:52Speaker 00

  At least 20 hours a week.

• 1:25:53Dr. Mary Claire Haver?

  So for our listeners, you know, what are the top three takeaways from practical optimism? You want them to understand.

• 1:26:01Speaker 00

  So, you know, practical optimism is eight pillars. If I would ask you to do three, I would say the first one is starting with purpose, having very clear intention. I say to people, write your purpose in pen, but your path in pencil. And what I mean by that is be flexible of how you achieve it. Some people are like, oh, I have to be this. Like I have young patients who are like, I want to be a doctor. And I'm like, okay. And then they try to go to med school and it didn't work out. And I was like, what's, what's, what's underlying? You want to help people? There's a thousand ways to help people and it doesn't have to be this. So being flexible when door A doesn't work, try door B, C, D, E, all the way to Z. Right? Don't take no for an answer when you want to accomplish something. So be very clear and intentional about what your purpose is. The second P is processing your emotions. If you don't manage your emotions, your emotions are going to manage you and they're going to show up in the form of physical illness.

• 1:26:46Speaker 00

  I always say that your body expresses what your mind cannot. So your body is going to become the stress manifestation. So your skin, your gut, all of that. So take care of the emotions by naming, claiming, taming and reframing. And if you can't reframe. I said, acceptance, it's huge. So there's eight, you know, having sense of agency and proficiency and self compassion, being present, people is one of the pillars. And then the last one is about practicing healthy habits. So taken as a totality, these eight pillars help you go from intention to execution. And practicing healthy habits is really just a stand in for, fill in the blank of what you want to accomplish in your life. And in order for you to accomplish it, you have to automate it. Take it out of the work of your frontal lobe, expensive CEO,

• 1:27:31Speaker 00

  we're not going to make them scrub the toilets. So automate it. And you do that by lowering the entry barrier, by having accountability, whether it's in the form of apps, doing things with friends. So those four Ms of mental health, movement, mastery, meaningful engagement, and mindfulness, you can do all four, going to some sort of a movement class, go to a movement class with friends and do it every week. All of a sudden you have mastery, right? If you're breathing and doing yoga, it's mindfulness, right? So if you take nothing else from this conversation, I would say the four Ms of mental health, put them in your phone in the notes section and start scheduling them this week.

• 1:28:04Dr. Mary Claire Haver?

  So you have mentioned a worry journal in your, in your book. Is this something that would be helpful for that? And what is a worry journal?

• 1:28:12Speaker 00

  So the idea of a worry journal is you spend about 10 minutes and just start worrying, write all your worries on a piece of paper. And I know you're looking at me.

• 1:28:20Dr. Mary Claire Haver?

  Different than the, what I was told to do of everything you're happy about, you know, your gratitude journal.

• 1:28:26Speaker 00

  Yeah. So you're looking at me like you're crazy. Why? And I know. So my therapist had given me this homework and that's how I first got onto it. I said, why would I worry? Like, who does that? I'm trying to get away from my worries. I don't need more of them. I already have enough in my head. And she was like, trust me, the idea is that you're taking all of your negative thoughts or worries and you're putting them on paper. So number one, you're getting it out. And just that act in itself gives you a little bit of like agency, like, yeah, and it gives you a little bit of control. And then what I realized is studies show that 85% of the time, the things that we worry about, they never actually happen. And then the 15% of the time that they do, we are more in control of the situation than we actually gave ourselves credit for. The other thing is that when you start to worry, you realize that there are themes

• 1:29:10Speaker 00

  and it's the same theme over and over and over again. Oh, my God, I'm going to make a fool of myself. Oh, my God, no one's going to like me. And that's not the case. And then you get to write in your worry diary, what actually happens? I have my patients write it. So if you're like, oh, my God, I'm going to ask a girl out or I'm going to try to make new friends and I'm going to get rejected. I say, write down and the things that you're worrying about, vast majority of the time, you don't get rejected. You are able to make a friend. Somebody does go with you on that coffee date. So worry helps you park it out of, take it out of your head and park it on paper. And then I say, the next step is that's the worry part. And if you wake up at 3:00 AM and you can't go back to sleep, write a worry journal. But the best thing you can do is schedule a worry sometime in the evening when you have time and do it preemptively. So you've already gotten rid.

• 1:29:55Speaker 00

  It's like a cleanse. It's like a toxic cleanse, a free 10 minute toxic cleanse. Get everything that you're worried about out on paper and it's not your responsibility.

• 1:30:03Dr. Mary Claire Haver?

  All right, Dr. Sue Varma, thank you so much for coming on UnPaused.

• 1:30:07Speaker 00

  Thank you. So great to talk to you.

• 1:30:10Dr. Mary Claire Haver?

  You can find Dr. Varma on Instagram at Dr. Sue Varma or through her website, Dr. Sue Varma dot com. Her book, Practical Optimism, is available wherever you buy books. I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at Dr. Mary Claire and get honest and accurate information on health, fitness, and navigating midlife at thepauselife.com. My new book, The New Perimenopause, is available now everywhere and anywhere you buy books and through our website. If you're loving this podcast, be sure to click follow on your favorite podcast app so you never miss an episode. While you're there, leave us a review and be sure to share the show with the women you love.

• 1:30:55Dr. Mary Claire Haver?

  We would be so grateful. You can also find full episodes on YouTube at Dr. Mary Claire. UnPaused is presented by Odyssey in conjunction with Pod People. I'm your host, Dr. Mary Claire Haver.