Can't Take Estrogen? Dr. Corinne Menn on Who Can, Who Can't & What's Changed

In this episode, Dr. Mary Claire Haver sits down with Dr. Corinne Menn to tackle one of the most common questions in women's health: "Can I take estrogen?" As a board-certified OB-GYN, certified menopause practitioner, and 24-year breast cancer survivor, Dr. Menn brings both professional expertise and lived experience to this conversation about who can take hormone therapy, who can't, and what's changed in recent years. Dr. Menn's own story provides powerful context for this discussion. At just 28 years old, during her second year of medical residency, she discovered a lump in her breast just one week before learning her mother had recurrent ovarian cancer. Within days of her mother's sudden death, Dr. Menn received her own devastating diagnosis: breast cancer. What followed was a grueling journey through mastectomy, chemotherapy, and induced menopause while simultaneously completing one of medicine's most demanding training programs. Throughout this conversation, Dr. Menn shares the profound gaps in survivorship care that she experienced firsthand and continues to witness in her patients today. The medical system, she explains, is focused on treating cancer but often fails to prepare women for the marathon of side effects that follow, particularly the devastating impact of estrogen deprivation on sexual health, mental health, bone density, and cardiovascular risk. Guest links: Dr. Corinne Menn https://www.drmenn.com/ Dr. Corinne Menn https://www.instagram.com/drmennobgyn/ (Instagram) Dr. Corinne Menn https://www.facebook.com/drmenn/ (Facebook) Dr. Corinne Menn https://www.myalloy.com/expert/corinne-menn-d-o?srsltid=AfmBOooqjlyB7FjhPpUAV8LsFqedivZu3OQGTNLhebnUtrRRxcQ-5a-4 (Alloy Health) Dr. Corinne Menn https://www.linkedin.com/in/drmenn/ (LinkedIn) Dr. Corinne Menn https://www.tiktok.com/@drmennobgyn (TikTok) Dr. Corinne Menn https://www.youtube.com/@drmenn (YouTube) Dr. Corinne Menn https://drmennobgyn.substack.com/ (Substack) Dr. Corinne Menn https://youngsurvival.org/about/corinne-menn-md (Young Survival Coalition) Books “The New Perimenopause,” https://thepauselife.com/pages/the-new-perimenopause-book?srsltid=AfmBOoqkbc2_wmfEQSfuf1fMT3s-ImuwNhUak8wC4KsEiYhHyNtQgSy5 by Dr. Mary Claire Haver “You Are Not Broken: Stop ‘Should-ing’ All Over Your Sex Life,” https://www.amazon.com/You-Are-Not-Broken-Should-ing/dp/1399813609 by Dr. Kelly Casperson ⁠"The New Menopause"⁠ https://www.amazon.com/New-Menopause-Navigating-Through-Hormonal/dp/059379625X/ref=sr_1_2?adgrpid=190238689390&dib=eyJ2IjoiMSJ9.djG88jtefTqLpTg36Li8QMNmXkpzLIfbFdY438Vro2vit_rKymy65UpF10hk_VTrxmazFUemwk7ywlmqHYY80j-V3LaeSD824-02PCtdlS8Fzp1XPcZs68nYHCL4V_ZdZBTJya---9Ng5PtKdOf-U3ENtuDXbDw68ULSk2wNk6Lt6mEhIPkuLM7FhztUzBJZ0wNBUQCSs6Pk1ZhoV2JDlzRapnMjnZgOq7PBA7Wy2KM._ZZSn21KJ43AyMvvSvI9_Hs3q74tpMBoCJ2zwi9enkc&dib_tag=se&hvadid=779626799212&hvdev=c&hvexpln=0&hvlocphy=9004331&hvnetw=g&hvocijid=16430100151400627515--&hvqmt=e&hvrand=16430100151400627515&hvtargid=kwd-2465259580440&hydadcr=15551_13558570_10211&keywords=perimenopause+book+mary+claire&mcid=ab159bad5384301d948e659e4b52f68d&qid=1774909744&sr=8-2 by Dr. Mary Claire Haver This episode explores: -Why family history of breast cancer is NOT a contraindication to HRT -The truth about Factor V Leiden, fibroids, endometriosis, and migraines: what really excludes you from hormone therapy -The concept ...

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

• 0:00Speaker 00

  So my whole thing is I want to try to find a way for women to have their cake and eat it too.

• 0:04Dr. Mary Claire Haver?

  Yeah.

• 0:05Speaker 00

  I want you to be treated for your breast cancer. I want you to stay on your medications. And if you need to be menopausal for them either forever or for some period of time, well, we need to support you in every other way because it's very hard for women to hear all the benefits of HRT and all the problems when you lose estrogen, especially early. It's scary.

• 0:24Dr. Mary Claire Haver?

  You lose the access.

• 0:25Speaker 00

  Dementia, osteoporosis risk, cardiovascular risk goes up. And so when you hear that, you're like, you're like, well, this is depressing. This sucks. Well, maybe I shouldn't be doing these breast cancer treatments. And I'm like, no, you need to do your treatments, but we need to find a way to make them tolerable, to improve your quality of life.

• 0:53Dr. 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. Today on UnPaused, I am joined by someone who feels like she's been in my life forever. Honestly, I can't even remember when Dr. Corinne Men and I first connected, probably through a social media post, but from that very first exchange, she's become one of the closest people in my professional circle. She's one of the women I literally text with every single day in our group chat, and I can't imagine this work without her. Dr.

• 1:36Dr. Mary Claire Haver?

  Men is a board certified obstetrician gynecologist, a certified menopause practitioner, and a medical advisor and prescribing doctor at Alloy Health, a menopause telehealth platform. She's also a 24-year survivor of breast cancer and premature menopause. Her story of loss, survival, and resilience is one of the most gut-wrenching and compelling I've ever heard. And beyond her story, she has taught me and so many others what true survivorship looks like, what risk reduction really means, and why centering the patient experience is just as important as the medicine is. She's also shown me how quality of life is not a luxury, but the very heart of patient care. I am so excited to share this conversation with her today. If you've ever

• 2:21Dr. Mary Claire Haver?

  been told you can't take estrogen, or if you've been labeled high risk because of a family history, a genetic mutation, or you're a pre-vivor or survivor yourself, this is an episode you cannot miss. I'm Dr. Mary Claire Haver, a board certified obstetrician and gynecologist and certified menopause practitioner. I'm also an adjunct professor of obstetrics and gynecology at the University of Texas Medical Branch. Welcome to UnPaused, the podcast where we cut through the silence and talk about what it really takes for women to thrive in the second half of life. Dr. Men, welcome to UnPaused.

• 2:57Speaker 00

  Thank you for having me.

• 2:58Dr. Mary Claire Haver?

  So, give me some backstory. Where did you grow up?

• 3:02Speaker 00

  I grew up in upstate New York in a pretty rural place with my younger brother.

• 3:06Dr. Mary Claire Haver?

  And then, did you know right away you wanted to be a doctor?

• 3:10Speaker 00

  Absolutely not. The famous thing is, I remember sitting like in a diner with my mom when I was in high school and thinking like, what am I gonna be? I kind of went through this like, I don't know, some career inventory list at the high school guidance counselor. I was like, no, no, no, no, like, and I was so nervous about that. But I always liked more the social sciences. So, social studies, anthropology, English, writing. And so, I was not the science girly. In fact, like, when they talked about the cardiovascular system in like, whatever science class, I would feel a little faint, like I was going to pass out. So then, you know, fast forward, I went to George Washington University in DC and I went in as a political science major and then pretty soon after, knew that

• 3:53Speaker 00

  wasn't for me. And then sophomore year, I'm like, I'm gonna be a double major in French and art history. And I was like, yay. And then I was like, no. And then I was like, oh, psychology's interesting. And then some, one day I got a little brochure in my like, student mailbox or whatever, for this, um, this biology and medical technology major. I just went and I was taking a required biology class and I really liked it. And I said, well, maybe, you know, women's health is interesting, like, I could do that. And I was like, I'm just gonna be pre-med. And everyone was like, what? You hate science. They're like, what? I was like, yeah, I'm just gonna do this. And that's it.

• 4:35Dr. Mary Claire Haver?

  And there you went.

• 4:36Speaker 00

  I liked that if I studied this, I could do this. And there was a clear path.

• 4:41Dr. Mary Claire Haver?

  Yes.

• 4:42Speaker 00

  My mom didn't go to college and my parents got divorced. And I saw kind of where that left her in some ways. And I felt a real burden, but it really made me want to have a path where I knew I was gonna get a job and be able to take care of myself. But really, looking back, if that had not been a concern, what I really wanted to be was a teacher. But there was this attitude back then and sometimes still now like, oh, you're not gonna make any money. Why would you do that?

• 5:09Dr. Mary Claire Haver?

  Yeah.

• 5:10Speaker 00

  But that's what I liked. And it's really funny because I feel like life has come full circle.

• 5:14Dr. Mary Claire Haver?

  Same.

• 5:15Speaker 00

  And now I'm a teacher.

• 5:16Dr. Mary Claire Haver?

  Same.

• 5:16Speaker 00

  And just in a different way.

• 5:17Dr. Mary Claire Haver?

  So my, my parents had, uh, they're still married. They were married, you know, my father passed away, but you know, they, they made it through all the things. But my aunts, several of them divorced on the young end. And I kind of watched. One of my aunts like had to move into like government sponsored housing because she was so destitute from her divorce. And I like remember that. So when I was growing up and making choices, I'm like, I have to do something where I'm not dependent on someone else for my livelihood and I can take care of any of my kids. And so I get it. Like I've got to be in the med school. I loved that. They take all the guesswork out. You just show up and here's your books and here's your classes. And the biggest decision is what do I want to specialize in?

• 6:01Speaker 00

  Yeah.

• 6:01Dr. Mary Claire Haver?

  So what made you pick OB GYN?

• 6:03Speaker 00

  So I think very early on, even when I was in undergrad, I says, well, I'm gonna do this pre-med thing. And I didn't have like a love of chemistry or physics. I just did those classes that I had to get through. But I was really like, okay, I could see myself in a caring field. So that's why I was attracted to medicine. And I thought, well, if I'm going to be in medicine, I think maternal health, women's health, that just always spoke to me. So it was just very early on, I just knew I was gonna do something in women's health. And so just OB GYN seemed like the natural thing, even though I knew it was a really tough specialty. But for me, it was really the only one.

• 6:40Dr. Mary Claire Haver?

  And then you start your residency. Your mother had ovarian cancer.

• 6:44Speaker 00

  Yeah, so I start residency in 2000, um, right after getting married. And so sometime in my first year of residency, my later in the year, my mom was diagnosed with ovarian cancer.

• 6:57Dr. Mary Claire Haver?

  Now, what kind of symptoms was she having?

• 6:59Speaker 00

  I don't even really know. At the time, it's a long story, but the time my mom was not living in this country and she had called me and was like, oh, just to let you know tomorrow, I don't know, they think I have these, I don't know, fibroids. It feels like I could actually feel it, like there's a grapefruit. And my mom was very petite and thin, and I suspect for a number of reasons, she just let her symptoms go. So she has a surgery, not in this country, and she tells me everything's okay. And I believed her. And what was really interesting is right before residency, I got married. And when she got off the plane, when I went to go pick her up before our wedding, I don't know what it was, as soon as she got off the plane, I saw her and my very first thought

• 7:44Speaker 00

  in my mind is, goodness, she looks like she has cancer. Like, I don't know why that thought came in my mind. I just think she was a little thinner, she looked a little gaunt in her face, but otherwise she appeared healthy. It was just this weird sense. I was not even a resident at that time, finishing up medical school, but you've seen enough patients to kind of know when someone's not right. So a little thought passed my mind and I let it go. So fast forward, then I start residency, you know, I get this call at the end of my first year, and she said she had masses removed from her ovaries, but everything was okay and she didn't need any further treatment. It was just a benign cyst. And I was like, okay. And I was busy. I was in residency. And she was just like, you're good, you do your thing, girl.

• 8:28Speaker 00

  Because she was supportive of me and she wanted me to, I don't think she wanted to pull me or my brother down with any burden of taking care of her. So then, fast forward, next year, second year of residency, I get a call, September of 2001, that she's got recurrent ovarian cancer. And so it was obviously spread, it was stage four. And so we were, we were kind of trying to coordinate how to get her home and what to do and all of that. And it was very stressful. And she was supposed to, my brother was supposed to fly down and bring her back, she was in Costa Rica. And the morning that she was supposed to come back, I was on call on the labor floor and my husband shows up.

• 9:11Speaker 00

  With security from, they wouldn't let people just up to the labor form like, David, what are you doing here? And he's like, come in the call room. I've got to tell you something. Your mom died last night. So she, she, she knew she was ill. She knew she was dying. She wanted to get home to us. And she just didn't make it. But the thing is, is a week before that, I felt a lump in my breast. And I was just a busy resident. And I was like, oh, it's probably just a little cyst, right?

• 9:39Dr. Mary Claire Haver?

  Right.

• 9:40Speaker 00

  I'll just watch it. And then I get this news that my mom has passed away. And so then I go into the mode of like, I was the eldest daughter.

• 9:49Dr. Mary Claire Haver?

  Yeah.

• 9:50Speaker 00

  My mom was not married. She was divorced. And so I had to arrange the funeral and call the relatives and get it all in order while being a resident.

• 9:58Dr. Mary Claire Haver?

  Yeah.

• 9:58Speaker 00

  And so I kind of let this little breast thing go.

• 10:01Dr. Mary Claire Haver?

  But to let our audience understand who don't understand medical residency, this was the years before duty hour.

• 10:06Speaker 00

  Yeah.

• 10:07Dr. Mary Claire Haver?

  Restrictions and we were working, we, we trained at the same time in different institutions. We didn't know each other, but we're, you know, hundred hour weeks were the norm.

• 10:16Speaker 00

  Very normal, yes.

• 10:17Dr. Mary Claire Haver?

  So huge patient loads, you know, incredibly aggressive training programs. And that's just what was built into the system. And to layer on your mother's illness, her sudden death, her funeral, all of the arrangements. She's living in Costa Rica. I, I, I didn't know this part of the story. All I knew was that.

• 10:37Speaker 00

  It was complicated.

• 10:38Dr. Mary Claire Haver?

  Your mom had died and right around that time, you found a lump in your breast.

• 10:41Speaker 00

  Yeah.

• 10:42Dr. Mary Claire Haver?

  So I, you were just balls to the wall. I mean, David, your husband.

• 10:47Speaker 00

  He is my savior. He's always been my savior. He's amazing and he's my backbone. And, you know, he helps get me through it. But you know what? When you're so busy, you don't have time to grieve or deal with anything. So I was just like, this is what I have to do. My program gave me a week off to deal with my mom's funeral.

• 11:04Dr. Mary Claire Haver?

  How nice of them.

• 11:05Speaker 00

  They were very supportive. Looking back, my, my residency program director and all my co-residents were actually incredible. And so then I, you know, came back a week later and.

• 11:17Speaker 00

  You know, when I came back from my mom's wake, I said to myself, I was like, damn, that sister's still there. And I had had my GIN feel it. And she says, let's just watch it with a few cycles. You're too young for breast cancer. You have no family history.

• 11:31Dr. Mary Claire Haver?

  Wait, did she know your mom had ovarian cancer?

• 11:34Speaker 00

  No, this was like before I felt it. And then we knew that my mom had so like, but even back then, this was 2001, there still wasn't a lot of widespread knowledge, even in the medical community of like this hereditary breast and ovarian cancer syndrome. Some, a lot of times, people didn't put the pieces together so much. And I was like, you know what? I still feel this. My fellow residents and some of the younger attending, so I was friends with who were women, I had them check it. They're like, yeah, just, you know, watch it for a couple of cycles, you know, you know, it's probably a fibromatoma. If it's still there, get it checked out. I really need to do this. So finally, December of 2001, I go in for an ultrasound and they're like, immediately want to do a biopsy. And

• 12:15Speaker 00

  still then, I was like, I literally wasn't scared. Looking back, I'm like, was I crazy? And I just kind of went home and I forgot about like them even calling me with the biopsy report. And then I was in the middle of prenatal clinic, seeing a woman, you know, for her, her pregnancy, and she didn't speak English. And the poor woman, you know, I get a page, there's no cell phones. And so I get the call, I answer it, and the radiology resident, who was sweet, we got your report, Crin, like, it's breast cancer. And I threw my pager across the room, screamed, started hysterical crying, the poor patient had no idea what was going on. The nurses and doctors come running into the exam room and, you know, they whisk me away and go and comfort me. But it was a shock. And the very, very first

• 13:00Speaker 00

  thought was not that I was going to die, nothing. It was that I might never be a mom. And damn, David married a lemon. That's what I thought.

• 13:09Dr. Mary Claire Haver?

  So first three days of this, like, did you go home? Did you take time off? Did you dry your tears and turn around and pick up the pager again and start seeing patients?

• 13:19Speaker 00

  I took a very little brief time off, but I knew I had to save my time off because I knew I had a lot ahead of me. And luckily, again, I had a supportive supportive colleagues. And remember, this was right before the holidays. It was like mid-December. And so luckily, my contacts in the medical world got me in to see the top breast surgeons and, you know, plastic surgeons in New York City. So I got a lot of access really fast. So it was a big whirlwind. And I just had to go in and make my decisions and move forward quickly.

• 13:51Dr. Mary Claire Haver?

  They gave you multiple options.

• 13:53Speaker 00

  They gave me multiple options because as a young woman with breast cancer, you know, there's a lot to think about. And we've come a long way since then, but at that time, breast conserving surgery, so having a lumpectomy was definitely a choice on the table. Having a mastectomy on just one side was on the table, having both done. And so I got like four opinions, kind of four slightly different treatment plans. And it was the surgeon who said to me when I sat across the table and I said, what would you do if this was your sister? And she said, Corinne, I would at very least do a mastectomy. But she goes, before you make a decision, I want you to go see the radiation oncologist. And I will always remember this.

• 14:38Speaker 00

  It was a young radiation oncologist because if you make this choice to have, say, a lumpectomy, you're going to have to have radiation. So you should really know what that means for you. Normally, you wouldn't go see the radiation oncologist till like later. And so then I met with that radiation oncologist and she says, Corinne, you're young. You've got many years to deal with a radiated breast and that skin. If you ever wanted reconstruction, there are late side effects of radiation on on heart, et cetera. And so she's like, just think about that. And she got a lot of pushback, she told me. They presented my case at grand rounds and she got a lot of pushback for like saying that to me. But I'm so glad she did because it was because of that that I was like, you're right.

• 15:22Speaker 00

  And I also knew myself psychologically, I was not really interested in lots of mammograms, et cetera.

• 15:27Dr. Mary Claire Haver?

  Right.

• 15:27Speaker 00

  But I did start with just one side, even though my gut said do both. Because everybody kept on saying, But you could get pregnant one day and maybe breastfeed. So there was that hope. I was like, okay, well, I'll save the other breast, right? But as soon as I was done with chemotherapy, I was like, take them both off because I am not dealing with the stress of repeated screenings. And I'm not saying to anybody listening that that would be the right decision for them. But for me at the time, it just felt like the right decision. And remember, I was tested genetically and it was negative for the BRCA 1 and 2 gene at that time. And we can circle back to that. But so I wasn't under the impression that I carry this, but my mom was only 54 when she passed. I was 20 to diagnosis.

• 16:11Speaker 00

  I was like, something's not right with my genes.

• 16:14Dr. Mary Claire Haver?

  Yeah.

• 16:14Speaker 00

  That's how I felt.

• 16:15Dr. Mary Claire Haver?

  So you're still a resident. You're still working all those hours. You are still managing these major surgeries. You did an outpatient mastectomy, is that right?

• 16:26Speaker 00

  Yes, so I chose my breast surgeon partially because I loved the center that she was associated with. And they had this beautiful, comprehensive cancer center where they had ambulatory surgery center. And she's like, Corinne, you can do your mastectomy as an outpatient. And I was like, I love that because I'm not sick. I don't need to be in the hospital. I'm not one of those sick people, right? Like, literally, that's how, from a psychological standpoint, I liked that idea. It sounded great on paper. But, you know, my case was long. It went for a long time. And by the time I got out, it was like the evening. And David and I, you know, we lived in Manhattan and we didn't have a car. And we had a ton of money at the time.

• 17:11Speaker 00

  They wheeled me out. And there was a yellow taxi cab to like, they shoved me in there and they brought me home. And, you know, anyone who's had surgery, especially one that was hours long, you're pumped with fluid. So I had to like, get up to go to the bathroom so frequently over that night. And I was in so much crushing pain on my chest, totally shell shocked. And I didn't have a mom there to take care of me. Thank God I had my amazing mother-in-law, who is like a mom to me. And so she was there to help me. It was really, really hard. And fast forward years later, when one of my friends had breast cancer and she stayed overnight for two nights in the hospital with her mastectomy, I actually cried because I was like, wow, it was really screwed up how they treated me.

• 17:54Dr. Mary Claire Haver?

  And you went back to work?

• 17:56Speaker 00

  I went back to work. I took like a week and a half off. And I went back to work because I knew that I might need to take more time off, but I was crossing my fingers. Initially, they said my lymph node was negative, but two weeks later, I got the phone call that there was a tiny area of cancer spread in my lymph node and that I was going to need chemotherapy, which was very devastating to me. So that's why I was was trying to be efficient with my time off. So yeah, went back to work.

• 18:24Dr. Mary Claire Haver?

  Now, let's go through the the post care. The top thing on your mind when you got the diagnosis was, am I going to be a mom?

• 18:31Speaker 00

  Yep.

• 18:32Dr. Mary Claire Haver?

  And how did that shape your future decision? So you've had your mastectomy, you're getting your chemo, and are they recommending having your ovaries removed?

• 18:41Speaker 00

  No, no. So before chemo, I was really lucky. So this is where I was heard as a patient because there was a lot of times where I was dismissed. But in this instance, I was heard and my doctors did really value my choice to preserve fertility, which, you know, for 2001.

• 18:56Dr. Mary Claire Haver?

  Let me ask, do you think that's because you were so young?

• 18:59Speaker 00

  I think it was because I was so young and because I was a doctor and because I was in New York City. And luckily, my oncologist is like, I'm going to get you in immediately with Dr. Okte, who, fast forward, presented at the Menopause Society Conference last year. And he, at the time, was doing groundbreaking work on creating a protocol of how young or breast cancer survivors, patients who were about to undergo chemotherapy, could safely, right, stimulate their ovaries and collect eggs and fertilize embryos because there was a concern, right? Like, I had estrogen receptor positive breast cancer, I was about to start chemotherapy, I knew what to follow was going to be ovarian suppression. So they're nervous about IVF. We've got a lot more data on how safe fertility preservation is in that setting,

• 19:44Speaker 00

  but at the time, they were nervous about it. And so he had this protocol where I was given Tamoxifen, and that's what was used to stimulate my ovaries. So I was able to have a few embryos saved in case chemo killed my ovaries, which was a huge blessing. So I was able to enter chemo.

• 20:02Dr. Mary Claire Haver?

  That's not cheap. Who paid for this?

• 20:04Speaker 00

  Insurance.

• 20:05Dr. Mary Claire Haver?

  Oh, thank God.

• 20:06Speaker 00

  Yes, but they probably, well, I'm not going to even get started on insurance now. But it was interesting. We, like, you know, it was a long time ago. This is almost 25 years ago. And my husband was at a big bank, so we had a really good insurance policy, but we never saw a dime. We never saw a bill. And we all know, I think in the past 25 years,

• 20:23Dr. Mary Claire Haver?

  Yeah.

• 20:23Speaker 00

  that's all changed for the worse. So I was very lucky. I never had any problems with insurance, but now I think a lot of the things might have been barriers.

• 20:32Dr. Mary Claire Haver?

  So you have some embryos frozen and then you go back to work?

• 20:37Speaker 00

  I go right back to work, start my chemo. And the beginning of chemo was hard, but I kind of, I was okay with it at first. And my program director allowed me to not take call. So I did as much clinic time and daytime work as I could. And my fellow residents picked up the call, which I'm forever grateful because it was a huge burden on them. But it really became after months and months of chemo. So as I was making that six month mark, it was just, it was getting so brutal, the side effects of chemo. And at the time, I thought it was the chemo. What I know now is it was the induced menopause from the toxicity of chemo

• 21:18Speaker 00

  on my ovaries. I didn't realize that me calling my husband at one o'clock in the afternoon saying, I feel like I'm crawling out of my skin and I want to jump out a window and I'm having a panic attack, or the very low mood and depression, because I'm a pretty resilient, upbeat person for people who know me, I could roll with a lot. But this was the first time in my life where I felt so, and of course, I was depressed about cancer, of course. But it was more than that. It was this darkness and gloom paired with a lot of insomnia, horrific hot flashes and night sweats.

• 21:48Dr. Mary Claire Haver?

  Did anyone whisper the word menopause to you?

• 21:50Speaker 00

  No.

• 21:51Dr. Mary Claire Haver?

  They're just, this is a chemotherapy.

• 21:53Speaker 00

  I mean, they said, oh, it might show, your ovaries might, you may not get your period, and they'll probably recover your ovaries because you are so young. And then at some point, I can't even remember, some point in the middle of my chemo, they're like, you know what, there's some studies showing that if we give you Lupron to really shut down your ovaries, that it might protect them from the chemotherapy. So on top of like the chemo kind of slowly shutting them down temporarily, then they gave me Lupron injections, which then I think just put me over the edge.

• 22:21Dr. Mary Claire Haver?

  Yeah. So Lupron is the medication that we give in a lot of fertility treatments, and they give in certain cancers where it basically completely, it's a, it's a chemical menopause and it's immediate.

• 22:32Speaker 00

  Immediate, yeah.

• 22:33Dr. Mary Claire Haver?

  So.

• 22:34Speaker 00

  And I just, honestly, I just really didn't know. I mean, I know it sounds silly that I'm an OB GYN, but remember, I was a second year resident, so I was still young and training. And that's when the WHI came out. It was 2002. There was no talk about premature menopause, menopause and all the other side effects. And if anything, I was like, it was the hot flashes. I didn't realize it was everything else.

• 22:54Dr. Mary Claire Haver?

  So when did chemo end?

• 22:55Speaker 00

  It ended sometime that's like late summer. I actually refused my last chemo. I could not take it anymore. And like a crazy person, I like called up the preeminent person in the world at the time, who was like an expert in young women and breast cancer. And I cold called him. I'll never forget it. I think he was at the University of Michigan. And he took my call. And I was just like, I know this is really weird, but I just want to tell you this. And I'm so scared that, you know, I'll never be a mom. And I want my ovaries to come back. And do you think I need that last dose of Taxitir? And he's like, no, it's okay. You don't need that one. It's okay. And I was like, oh, okay. So I went to my oncologist. I'm like, I'm not doing the last one. She was just, you are the biggest

• 23:38Speaker 00

  pain in the ass patient. But she supported me on that. And then they're like, okay, let's kick you while you're down. And now let's put you on Domoxifin and ovarian suppression. So my new line is that, listen, we have got to think about someone who has had breast cancer or some other complicated medical thing, but breast cancer, they've been through surgery, they've been emotional stress of being diagnosed with cancer, they've had all these treatments, chemotherapy. And then, when they're done, they're like, okay, now, when you're really low, now we're going to put you on prolonged estrogen deprivation for five to 10 years. But we're not going to prepare you for any of it. To me, it's like kicking a dog when they're down. That's how I felt. And in retrospect, I'm like,

• 24:21Speaker 00

  whoa, whoa, whoa. When we are embarking on that, we really need to empower women so that we can optimize things, be like, come on, come on, girl, we got to get you ready for the marathon. Because it's a marathon. It is not a sprint. And that conversation isn't always happening.

• 24:38Dr. Mary Claire Haver?

  And there's so much rush. Rush to get the chemo, rush to get the surgery, rush.

• 24:42Speaker 00

  I understand that. And that's important. But there are times where I say, it's okay to just like, take a pause and be like, we've got to regroup, reboot for this next phase. And I never really had that chance along the way.

• 24:55Dr. Mary Claire Haver?

  So you talk about all the stuff they gave you before chemo.

• 24:59Speaker 00

  Prophylactically, stuff for nausea. Yeah. Talk about that. Yeah. So when you go in- The listeners are taking notes right now. Yeah. So when you go in for chemotherapy, they give you a steroid, like a dose of predazone. They give you anti-nausea medication, multiple different choices. They gave me injections, neupigent to keep my white blood cell counts up. They give you Ativan while you're getting the red devil, he drew a mysin to help like, keep you from like having a panic attack- Spinning out. During that- Crashing out, as the kids say. Yeah, crashing out during that chemo infusion. But they didn't give me anything or offer anything to help me cope with the induced menopause that was about to happen and was happening.

• 25:40Speaker 00

  So for instance, I didn't know at the time at all anything about genital urinary syndrome menopause, but that was like a foreign thing. I didn't know and never said that to me. So for our listeners, what is genital urinary syndrome? Yeah. It's when loss of estrogen, the vagina, vaginal dryness, vulvar atrophy, clitoral atrophy, like, yes, it's more than vaginal dryness. Everything is drier, shrinking, thinner, poor quality tissue, decreased lubrication, pain with sex, decreased sensation, urinary, but it's urinary syndrome too. So urinary tract infections, urinary urgency and frequency. So of course that was happening to me. So that's just one example of, I didn't even get like use a moisturizer or lubricant or these are the things you can do.

• 26:25Speaker 00

  No one gave you a tub of coconut oil? Well, no, because this was 2001 to into 2002. Like, no one was talking about sexual health with cancer treatments. I mean, we've come a long way and we're doing better, but got to remember at the time it was not at all addressed, right? And so now I say like, okay, if I could have looked back, I would have said, oh, let's pre-medicate her, give her like the lowest dose of vaginal estrogen like twice a week to prevent the downward decline. Yeah. Because we know, we know the hot flushes are coming. Let's offer this woman something. We know she's likely at very high risk for mood issues, anxiety and depression.

• 27:06Speaker 00

  But I was never offered an antidepressant or even the talk of it until years later, like literally years later, when I don't even know, it was like probably five years into treatment on demoxifen. And finally, the nurse practitioner, the new medical oncologist that I went to, she was so lovely. She's like, Corinne. You don't need to suffer. She wrote me a prescription for an SSRI and I was like, oh, okay, maybe that will halt my hot flashes. I mean, it was crazy.

• 27:32Dr. Mary Claire Haver?

  Five years of it.

• 27:33Speaker 00

  And I actually have, I, I pulled my medical records. I have the note from the middle of chemo when I was almost about to just like lose my mind and like stop taking the chemo. And in the note, it says, the doctor wrote, like horrible hot flashes, hasn't slept in months. She's terrified of premature menopause. That was the line. And then I looked at the plan and the plan was prescription for Ambien. That was it. That basically sums it up.

• 28:02Dr. Mary Claire Haver?

  So you did have a baby?

• 28:04Speaker 00

  I did.

• 28:06Dr. Mary Claire Haver?

  So walk me through that. You were allowed?

• 28:07Speaker 00

  Yeah. So I finished up chemo and then at the time they just, that I started Tamoxifen. And Tamoxifen does not cause you to go into menopause. It just blocks receptors.

• 28:19Dr. Mary Claire Haver?

  So you feel like you're menopausal. It doesn't destroy your ovaries?

• 28:22Speaker 00

  Yeah, you can have menopausal symptoms, but because I was very young and at that point, they, they stopped the loop run. They stopped the forced menopause. They're like, let's just see what happens with your ovaries. And so I started Tamoxifen and I actually tolerated it okay, because slowly over the months, my ovarian function came back, right? And so I was doing okay on it, right? And at about the 18 month mark, I decided, sort of on my own, I was a little bit of a cowgirl about it. I was like, yeah, I'm gonna just stop this. I'm going to get pregnant and then I'll go back on it. And that is what we tell patients they can do now. So there was recently something called the positive trial that looked at young

• 29:03Speaker 00

  women like me, where they would pause their adjuvant endocrine therapy, so Tamoxifen aromatase inhibitors, for up to two years to get pregnant, either naturally or use IVF, have the baby, even breastfeed if they could. So this two year pause, and then you go back on to complete your treatment. So I basically did the positive trial on myself back then. And, and, and my doctors were sort of supportive of it, because at the time, there was observational data that pregnancy after breast cancer didn't seem to

• 29:33Dr. Mary Claire Haver?

  Increase the recurrence.

• 29:34Speaker 00

  Recurrence risk or, or change the prognosis. And so I was like, I'm gonna do this. And we didn't need to use our frozen embryos. We were really lucky, like literally, we had sex. 11 days later, I was a crazy person and I drew my own blood in the call room and I ran it down to the lab and an hour later, I go onto the computer and like my HCG was like, I don't know. It was like

• 29:57Dr. Mary Claire Haver?

  Forty-seven.

• 29:58Speaker 00

  No.

• 29:59Dr. Mary Claire Haver?

  Not even that high?

• 30:00Speaker 00

  No, it was like 16. It was so low, I think I had

• 30:03Dr. Mary Claire Haver?

  This is like, you wouldn't even have a positive pregnancy test.

• 30:05Speaker 00

  No, no, it was like, yeah, it wasn't even

• 30:08Dr. Mary Claire Haver?

  Like urine.

• 30:08Speaker 00

  I hadn't even missed a period yet. I didn't even miss a period yet. And I was crazy. And then like 36 hours later, I drew my blood again and I did it again.

• 30:15Dr. Mary Claire Haver?

  It's doubling.

• 30:16Speaker 00

  Yeah.

• 30:17Dr. Mary Claire Haver?

  And that's Ava.

• 30:18Speaker 00

  And that's Ava.

• 30:18Dr. Mary Claire Haver?

  Yeah.

• 30:19Speaker 00

  And she's 21 now.

• 30:25Dr. Mary Claire Haver?

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• 31:15Dr. Mary Claire Haver?

  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. You've had multiple surgeries since then, too many.

• 31:37Speaker 00

  Yeah.

• 31:37Dr. Mary Claire Haver?

  Lots of reconstruction.

• 31:38Speaker 00

  Yeah.

• 31:39Dr. Mary Claire Haver?

  You have become a leader in this space in medical communication.

• 31:45Dr. Mary Claire Haver?

  Especially around survivorship and pre-vivorship. What is the, and I hope I pronounced it correctly. What is the Young Survival Coalition?

• 31:53Speaker 00

  So, the Young Survival Coalition is the premier nonprofit organization worldwide that addresses breast cancer in women 40 and younger. Because our needs are different, they're unique, and more impactful in ways that aren't in someone who is menopausal, say, when they have breast cancer, right?

• 32:11Dr. Mary Claire Haver?

  I mean, my DMs constantly, constantly. Every time I post about menopause or estrogen. There's at least 10 or 15 people, "What about me? What about me?"

• 32:20Speaker 00

  Yeah, a breast cancer survivor.

• 32:21Dr. Mary Claire Haver?

  Next, the survivors, the pre-vivors. Or people have just been told, "You're too high risk. You can't take estrogen."

• 32:26Speaker 00

  Yeah.

• 32:26Dr. Mary Claire Haver?

  And they just feel like they're left in the dust.

• 32:28Speaker 00

  Absolutely. And so that feeling of left in the dust, I felt it, not in terms of the menopausal Conversation HRT at the time, but even when I was diagnosed, I felt left in the dust because I was the youngest person in the chemo room and I didn't relate to like the support group, women who were much older than me. So the YSC became a real lifeline. And I feel like it's a similar reflection of the community that I have now in the menopause space. And they were really like my sisters in arms at the time, advocating for what we needed. But now, full circle, now me being a menopause specialist, now I'm trying to speak to the needs of those young survivors who, like me, are dealing with premature menopause,

• 33:11Speaker 00

  they're dealing with GSM, Genital Urinary Syndrome, sexual health stuff, and they're not getting answers from their doctors. What they're allowed to do is get pregnant, but no one is talking to them about, "Oh, well, does it hurt when you try to get pregnant because the sex is so painful?"

• 33:26Dr. Mary Claire Haver?

  Yeah.

• 33:26Speaker 00

  You have a choice as an adult woman to make a risk benefit decision for yourself to pause adjuvant endocrine therapy to attempt pregnancy.

• 33:35Dr. Mary Claire Haver?

  So, most women don't understand this. It's really a radical concept, especially in the oncology space, that a patient would...

• 33:44Dr. Mary Claire Haver?

  Have as much input into the decision making around her care. It's almost like, it's like medical school. Here, here you go. Here's your plan. Here's your chemo, da, da, da, and you're lucky to be alive.

• 33:53Speaker 00

  Yes.

• 33:53Dr. Mary Claire Haver?

  Like you've described stories of people coming to you after they find you on the internet and talking about their experiences.

• 34:00Speaker 00

  Yes.

• 34:00Dr. Mary Claire Haver?

  Like, give me, you know, these, again, they're taking notes.

• 34:03Speaker 00

  Yes.

• 34:04Dr. Mary Claire Haver?

  You know, what should they not hear?

• 34:05Speaker 00

  Well, listen, I think most medical oncologists out there, I am so grateful for them. And I, and they do want shared decision making. They, they, they're so smart and they know all the ins and outs of these things. But the reality is they are working in the same medical system that you and I worked in. And they are pressured for time.

• 34:25Dr. Mary Claire Haver?

  Yeah.

• 34:25Speaker 00

  They're pressured from a hierarchy of an institutionalized, like, protocol. They're afraid of all sorts of-

• 34:32Dr. Mary Claire Haver?

  The medical legal.

• 34:33Speaker 00

  The medical legal stuff, the insurance things. So I think even with the best intentions, it's very, very, very hard for women to get individualized care. And then when this elephant in the room of like the fear of, of death. I mean, I feared it for years. I mean, it's still sitting in the back of my mind, recurrence and mortality. When that enters the room, it really gets in the way. It's like, you know, and if, if a, a medical oncologist, or increasingly, there's, there's a lot of, you know, there's nurse practitioners and PAs who are also seeing these patients. If they don't have that kind of clinical expertise or interest in helping with sexual health, or the menopausal symptoms, or premature, or the mental health and stuff that's going on, all these other things, it's just easier to be like, wow, you know, you don't want

• 35:17Speaker 00

  to risk recurrence. You have to stay the course and do the most. And sometimes doing the most leads to people stopping treatment, not completing treatment, or just really suffering. So my whole thing is I want to try to find a way for women to have their cake and eat it too. I want you to be treated for your breast cancer. I want you to stay on your medications. And if you need to be menopausal for them, either forever or for some period of time, well, we need to support you in every other way. Because it's very hard for women to hear all the benefits of HRT and all the problems when you lose estrogen, especially early. It's scary.

• 35:53Dr. Mary Claire Haver?

  You lose access.

• 35:55Speaker 00

  Dementia, osteoporosis risk, cardiovascular risk goes up. And so when you hear that, you're like- You're like, well, this is depressing. This sucks. Well, maybe I shouldn't be doing these breast cancer treatments. And I'm like, no, you need to do your treatments, but we need to find a way to make them tolerable, to improve your quality of life. And there's lots of ways we can support your long-term health, even if we can't do systemic hormones. And this is why it is maddening and it's sickening to me that we would ever deny women safe things like local low-dose vaginal hormones, vaginal estrogen. Because I like to picture, there's all these bricks on your, on your back. You're, as a cancer survivor, you're dealing with all of these struggles.

• 36:38Speaker 00

  And if you just take one or two of the bricks off that woman's back, she could stand a little straighter and she could feel a little bit more like herself. So I might not be able to give her systemic estrogen in many cases.

• 36:51Dr. Mary Claire Haver?

  Yeah.

• 36:51Speaker 00

  Although maybe down the road, we can talk about that. But I can give her local vaginal estrogen and maybe she could have sex with her partner and get, keep with the intimacy. Maybe she doesn't have to go to the bathroom five times, you know, a night. Maybe riding a bike or hiking doesn't hurt because it's so painful and dry down there. Maybe she could have a pap smear. I had two patients in the past couple of weeks who can't have pap smears anymore because the aromatase inhibitors have made their vulvas, the vaginas, so atrophic and stenotic that they can't tolerate a speculum. So they can't have cervical cancer screening. That's not okay.

• 37:26Dr. Mary Claire Haver?

  Yeah.

• 37:26Speaker 00

  It's insane. And these are women who are already past treatment, stage one. Like the lack of knowledge in the oncology community about the importance of just this one little thing. I hate to harp on this.

• 37:38Dr. Mary Claire Haver?

  No, but it's, it's everything.

• 37:39Speaker 00

  It, like, this one thing affects intimacy, relationships, your urinary health. It affects like your ability to have a damn pap smear to get cervical cancer screening. Like, come on, people.

• 37:50Dr. Mary Claire Haver?

  These are now, as I've come to learn, I did not learn this in residency or training, but the mental health, the cognitive changes, the genital year. I did know about some of the genital urinary changes, but not all, are expected and predictable.

• 38:03Speaker 00

  We know they're coming.

• 38:04Dr. Mary Claire Haver?

  It's not like it's not going to happen. It's going to happen to every woman in menopause. And every doctor involved in this care, like, we're failing. The medical system is failing women. Because we are not training these clinicians. They're good people. They want to do the right thing. And the bias that is just built into this of you're worried about your vagina?

• 38:25Speaker 00

  Yeah.

• 38:25Dr. Mary Claire Haver?

  How dare you?

• 38:26Speaker 00

  Actually, my medical oncologist, who is still practicing, saw one of my patients. And she didn't know that it was one of my patients. The patient found me afterwards. And when the patient asked to have vaginal estrogen, and the patient is a complicated. She had recurrent breast cancer. She's at high risk for not a good outcome. But her GSM was incredibly severe. Her 20-year marriage collapsed and her husband left her. And she was really just, just like, please, can I consider some vaginal estrogen? And, you know, I'm really worried about my heart health. And my oncologist slammed, well, my old oncologist slammed her hand on the desk and said, is this about your goddamn vagina? Use some coconut oil.

• 39:09Speaker 00

  And if you're worried about your heart health, go see a cardiologist. I'm here to save your life. And so that's an extreme example. Some things have changed, some things have not. There's much more awareness. There's a lot of medical oncologists.

• 39:22Dr. Mary Claire Haver?

  Well, the AUA guidelines.

• 39:23Speaker 00

  The AUA guidelines.

• 39:24Dr. Mary Claire Haver?

  Yeah, American Urological Association.

• 39:26Speaker 00

  Yes, and ASCO is having more of this content.

• 39:29Dr. Mary Claire Haver?

  What is ASCO?

• 39:30Speaker 00

  American Study Clinical Oncology. Those leaders, my friend, Dr. Eleanor Tepelinski, shout out to her. She's a leading voice out there trying to bridge this gap and help communicate with the, the menopause specialists need to communicate with the oncologists. As all the psychiatrists need to communicate with the menopause specialists. The orthopods need to communicate. Because we're all seeing the impacts of menopause. And I use the breast cancer patient as the most extreme example. But everything we talked about also applies to the woman with endometriosis, the woman with premature ovarian insufficiency for a reason that we don't even know why it happened. For the woman who just had a complicated menopausal. Um, situation because maybe she has some other comorbidity of, I don't know. She's got hypertension or something and someone told her she couldn't have this

• 40:15Speaker 00

  or a family history of breast cancer. So they tell her she can't have that or that, right? So this is the, the most extreme example, but it applies to really all women, I find.

• 40:24Dr. Mary Claire Haver?

  Yeah. So you finish residency, you make it through.

• 40:28Speaker 00

  Yeah.

• 40:29Dr. Mary Claire Haver?

  And then you work, you go to work.

• 40:31Speaker 00

  Yep.

• 40:31Dr. Mary Claire Haver?

  And a traditional OB GYN practice.

• 40:33Speaker 00

  Yeah. So my first job is actually in a community health center because it was really close to my house. So I could like come home for lunch to see my daughter Ava. Um, and so I did that for a little bit. And then my friend from the Young Survival Coalition, who became like a sister to me, she had a recurrence of her breast cancer. Our breast cancers were very, very different. Um, she had a recurrence, um, when she was pregnant and, um, and she, she delivered her baby and, and she died two weeks later. And while we were in the hospital there, my husband said to me, he's like, you're not getting pregnant again. You're going to stay in your Tamoxifen.

• 41:04Dr. Mary Claire Haver?

  It scared him so bad.

• 41:05Speaker 00

  Yeah. And you know what? He was right because Nicole's situation was very different and I, I, I can't compare our, our medical diagnoses in terms of our breast cancers were very, very different. But at the time I just said, I have a daughter. She's healthy, wonderful husband. I'm going to stick on my medication. I'm gonna, I'm gonna do what I need to do. I can't pause again. And then that's when, because I make decisions like, like literally two weeks later, we have an agency, we're going, we're going to do an international adoption and we adopted Lucia from Guatemala. She was born in two thousand and six and she came home at the very end of two thousand

• 41:41Dr. Mary Claire Haver?

  And she's a sophomore in college?

• 41:42Speaker 00

  She's a sophomore. She's 19. Yeah. And so, yeah, so I say Ava saved me emotionally because I was in a very dark place thinking I'd never be a mom. And then Lucia, I say, saved me physically because, because of her, I was allowed to stay on my, my, my Tamoxifen. Yeah.

• 42:01Dr. Mary Claire Haver?

  When did you decide? To make the switch to menopause care.

• 42:05Speaker 00

  So after I got back from taking care of Lucy's adoption, I chose to have my ovaries removed at that time because I was like, I'm not going to have another baby. Well, I'm not going to have another baby. I was BRCA negative. And so the doctor was like, you don't have to do this, Corinne. Well, I was like, I'm going in for a new reconstruction. They were fixing my, my breast implants. And I says, well, I'm under, just take the damn things out. I don't want them anymore. My mom died at 54. I know you all tell me I'm BRCA negative, but there's something not right with my genes, I said. They're like, you don't have to. I'm like, no, it's okay. I'll do it. I don't even, I'm glad I did it. We'll tell the audience why in a little bit, but again, clueless. I didn't really realize what surgical menopause was going to mean for me and bam.

• 42:46Dr. Mary Claire Haver?

  Talk to our listeners about the differences between abrupt menopause, surgical, you know, induced menopause and natural menopause.

• 42:56Speaker 00

  Surgical menopause is abrupt because you walk in to the OR with ovarian hormones being produced. And then you walk out, those ovaries are removed, there's no more production of estrogen, progesterone, and you're losing a big source of your testosterone. Testosterone is made in other places. And so from a symptom standpoint, it's more abrupt and more severe and it's permanent. And I think I didn't realize it because my other menopause times were temporarily and chemo kind of gradually put me in and then, you know, and then again with the loop on. So I don't think, and I was like, oh, I weathered that.

• 43:33Dr. Mary Claire Haver?

  And you were older.

• 43:34Speaker 00

  And I weathered that and I was just like, I was in a better place. I had my two kids. I'm like, I can handle this, right? But it was really hard. So when I realized like, wow, over two months, I got like, I gained weight. I gained like at least 10 pounds really quickly. The sleep, all the things, right? All the stuff. And then I was in a private practice. I was starting to see more women coming in with perimenopause and menopause complaints. I'm like, I need to figure this stuff out. I'm like, because I am not capable of taking care of my own patients with these complaints, much less someone like me who is very complicated. And so then I got involved in the menopause society and I got certified and just started to like, Slowly tailor my practice in that kind of way.

• 44:13Dr. Mary Claire Haver?

  And when did you make the switch to you're working with Alloy Health now with a telemedicine platform?

• 44:18Speaker 00

  Yeah, I stopped doing OB around that time of switching towards menopausal.

• 44:23Dr. Mary Claire Haver?

  Delivering babies, which a lot of us do eventually because babies come when they want to come and we have to sleep.

• 44:29Speaker 00

  Exactly. So it was, I don't know, it was probably sometime around 2010, 2011, I stopped OB, switched to GYN, office-based practice only, and then COVID hit. And I just started to do a little bit of telehealth just for my established patients during COVID because in New York, you know, no one was coming into the doctor. And by that point, my daughters were in high school and I was trying to be there for them and supportive of them with their high school years. And I was like, you know what, this telehealth thing kind of works for a lot of education. Menopause is a lot of talking. Breast cancer survivorship is a lot of talking. It's a lot of like education.

• 45:02Dr. Mary Claire Haver?

  Taking a visit is not going to cut it.

• 45:04Speaker 00

  Yeah. And also I didn't need to examine these patients in the same way. Like they can still have their GYN. I'm not replacing their gynecologist to do their in-person exams. But I says, this works. And then I was at a menopause society conference in Washington DC. And Monica Malinor and Anne Fulenwetter, the co-founders and co-CEOs were there. They had a little booth and I met them. I'm like, I do telehealth and I do menopause. They're like, oh, we're going to start a menopause telehealth company. I was like, oh, we should talk. And so we stayed in contact and then I joined them and got a lot of medical licenses and started to see patients in a lot of states through Alloy. But also still maintained my own small telehealth practice. So, you know, over, so fast forward over the last like, I'd say, you know, three, four years, I've really,

• 45:46Speaker 00

  I've learned a lot because the more you see, the more you learn.

• 45:50Dr. Mary Claire Haver?

  Yeah.

• 45:50Speaker 00

  So I've learned a lot by really only focusing on this. It makes you a better menopause doctor. And so now I'm like really on my mission to, because I have all this experience now to really help the most dismissed, the most complicated. And so I'm coming back to what I always wanted to be, which was a teacher.

• 46:14Dr. Mary Claire Haver?

  There's a lot of, "I can't take estrogen. I've been told X, Y, and Z." What are some legitimate reasons? Because there's so much misunderstanding, even amongst clinicians,

• 46:23Speaker 00

  Yeah.

• 46:24Dr. Mary Claire Haver?

  as to who can and cannot take. So, in medicine, we call it an absolute contraindication. What are the absolute contraindications to someone taking estrogen?

• 46:34Speaker 00

  So, I'll be bold and say, I don't believe in medicine there are any absolutes.

• 46:38Dr. Mary Claire Haver?

  Yeah, as Dr. Bloming says. It's not cyanide.

• 46:42Speaker 00

  Yes, and I think, so what I like to say is like, listen, yes, we have some general contraindications that we're always going to talk about. You have unexplained bleeding, postmenopausal bleeding. We've got to work that up and figure out what's going on.

• 46:53Dr. Mary Claire Haver?

  Meaning, you're having vaginal bleeding, not your normal, right? We don't want to start hormone therapy in that case because there might be something there that the estrogen would feed, and we have to figure that out.

• 47:02Speaker 00

  Absolutely, especially postmenopausal bleeding, or really nuanced, a very heavy, very abnormal bleeding in the perimenopause. You have some real active liver disease, complicated active liver disease. You've had a recent thrombosis, so a blood clot, or a blood clot that goes to your lung called a pulmonary embolism, right? We're going to be very careful there. You have complex cardiovascular disease, like a massive heart attack, a bypass, something significant. Hypertension, high cholesterol is not serious cardiovascular.

• 47:31Dr. Mary Claire Haver?

  Right, women are being told if they have any risk factors for heart disease, they can't take it.

• 47:34Speaker 00

  Yeah, no.

• 47:35Dr. Mary Claire Haver?

  If they have any family history of breast cancer, they can't take it, even with negative gene testing.

• 47:39Speaker 00

  Exactly, and then the last one, as you personally have an estrogen-dependent breast cancer, new diagnosis in the middle of breast cancer treatment, right? Those are the big ones. But like, we can find things in really most of those scenarios where there might be situations where we could consider it in the right context, right? So, those are the big things. But notice, none of those were a family history of anything, right? So, the biggest one, the biggest barrier that we get is family history of breast cancer. That is not a contraindication to hormone therapy. I tell patients, "I want to know your family history, and I want to know your other..." Because it's not just family history. We need to look at all of your risks for breast cancer so that we can personalize your screening.

• 48:20Speaker 00

  Talk to you about preventative measures, both lifestyle, sometimes medication, even surgery, depending on you're the most high risk, like you carry a BRCA mutation, for instance. But it's to do those things. It's not to deny you a conversation about your choices on hormone therapy. And the Menopause Society makes this very clear, so don't take my word for it. Look at the experts and the guidelines that are generally on the more conservative side. And it says that the preponderance of evidence does not show that menopausal hormone therapy further adds to your risk of breast cancer. Your risk is elevated. It's elevated. We're going to address that with your screening, surveillance, et cetera. But adding menopausal hormone therapy isn't going to significantly increase that risk more.

• 49:05Speaker 00

  That's how you have to think about it. And so that family history is often used as like a

• 49:10Dr. Mary Claire Haver?

  A guillotine.

• 49:11Speaker 00

  Yeah.

• 49:12Dr. Mary Claire Haver?

  To say absolutely no. You talk a lot about weird Barbie. It's weird Barbie.

• 49:17Speaker 00

  So the weird Barbie is this is ideas that the doctors now are coming to the place where they're like, okay, we get it. This menopause train is happening. We've got to get along with the ride. Okay, I'll learn how to prescribe hormone therapy for the ideal, perfect candidate, like this ideal stereotypical.

• 49:32Dr. Mary Claire Haver?

  Thin.

• 49:33Speaker 00

  Perfect.

• 49:34Dr. Mary Claire Haver?

  Caucasian, healthy, you know, no risk factors. Like, yes, you can have it.

• 49:39Speaker 00

  Exactly. Like, your breast density is zero, there's no family history.

• 49:43Dr. Mary Claire Haver?

  Yeah.

• 49:44Speaker 00

  Et cetera. But we're all weird Barbies, we're all unique and different, we all bring different things to the table, whether it's like 80% of us, by the time we're 50, will have some other medical condition. Migraines with aura, hypertension.

• 49:58Dr. Mary Claire Haver?

  Endometriosis.

• 49:59Speaker 00

  Endometriosis.

• 50:00Dr. Mary Claire Haver?

  Fibroids. Women right now, I get blowing up.

• 50:02Speaker 00

  Yes.

• 50:03Dr. Mary Claire Haver?

  Oh, I have fibroids, I've been told I can't take it. Oh, I have endometriosis, I've been told I can't take it.

• 50:08Speaker 00

  That's true.

• 50:09Dr. Mary Claire Haver?

  Yeah. Oh, I have autoimmune disease, I've been told I can't take it. Migraines with aura.

• 50:12Speaker 00

  Yeah. Factor V Leiden. It's like the bane of my existence. Factor V Leiden.

• 50:18Dr. Mary Claire Haver?

  MTHFR.

• 50:21Speaker 00

  So these inherited clotting situations, prothrombin factor V, I mean, great example of individualization matters. We can give you transdermal estrogen, we would just avoid oral.

• 50:32Dr. Mary Claire Haver?

  Right.

• 50:32Speaker 00

  It doesn't mean you can't.

• 50:33Dr. Mary Claire Haver?

  Yeah, so we do not increase the risk of a blood clot with a non-oral estrogen formulation.

• 50:40Speaker 00

  Exactly.

• 50:41Dr. Mary Claire Haver?

  Let's talk about some statistics that you love to throw out there. One in eight women lose ovarian function before natural menopause.

• 50:49Speaker 00

  Yeah, that's a inconvenient one in eight. And I, so I say the one in eight, everyone thinks, oh, one in eight women will get breast cancer in their lifetime. And that is true if you live to 80. It's not one in eight women at age 40.

• 50:59Dr. Mary Claire Haver?

  Right, each decade, no.

• 51:00Speaker 00

  Yeah. No one talks about that one in eight women are going to lose their ovarian function prior to the age of natural menopause. Average age is about 51, right? Ranges from 45 to 46. So that's a lot of women. So premature menopause is under 40, early menopause is under 45.

• 51:16Dr. Mary Claire Haver?

  Okay.

• 51:16Speaker 00

  And

• 51:17Dr. Mary Claire Haver?

  And there's some specific risks associated with early and premature menopause that a lot of women don't know. I mean, I can't tell you, people coming into my office who had ovaries out with surgery, electively, at 45, and no one counseled them as to the earlier loss of hormones and what that would do to her long-term risk of chronic disease.

• 51:40Speaker 00

  I mean, it is, it's shocking. And in my mind, it is medical malpractice to remove somebody's ovaries prematurely and not have pre-op counseling, pre-op plan. There are many good reasons why we move ovaries early.

• 51:55Dr. Mary Claire Haver?

  Oh, yeah.

• 51:55Speaker 00

  I removed mine. I am so glad I did because fast forward years later, I found out on update testing that I do carry a BRCA2 mutation. My gut was right. I'm glad I did it.

• 52:05Dr. Mary Claire Haver?

  What is update testing? This is important because most, a lot of women don't understand

• 52:08Speaker 00

  A little sidebar here. So, family history of breast cancer, you get tested for a gene or you say, oh, my mom is tested for that because she had breast cancer and it was negative. Anybody listening, if you had testing really prior to 2014, 2013, 2014, you should speak to a certified genetic counselor or your physician, or ask for a referral to a genetic counselor. Because prior to that time, we didn't do panel testing. So we didn't include other genes because it's not just BRCA. There's other genes. That can raise the risk of ovarian and breast cancer. But they didn't even do the full sequence of the BRC gene. They just did like the, the most common mutations. And my mutation is in something called the BARTS sequence,

• 52:53Speaker 00

  which is the large rearrangement of the gene. It's less common, but it exists. So if you had a negative rocket test in your family prior to that time, you need update testing. And when I called my uncle, I think I need update testing. Cause I was doing all this like continuing medical education and I read about it. And he's like, oh, you don't probably need it. It's really rare. I was like, just do it. And then three weeks later, he's like, oh, I've got bad news. I'm like, no, it's good news. Because now I know why, because now I could have my family members tested. And you know, they can take proactive steps, right? So that gets back to why would someone remove their ovaries early? And with enhanced, there's more women having genetic testing out there, which is good. Um, so we know. And then they're done with their babies, having babies. Okay, you don't need your ovaries anymore in terms of the fertility perspective.

• 53:39Speaker 00

  So we can remove them surgically. You could have your cake and eat it too. You can lower your risk of ovarian cancer. You will wake up in the recovery room with that estrogen patch on you. We can give you progesterone, we can give you testosterone. We can manage it. So you've lowered your risk and you get your hormones back.

• 53:54Dr. Mary Claire Haver?

  And that confuses a lot of women. Why would you remove my ovaries and then give me hormones back? Isn't that going to increase my risk?

• 53:59Speaker 00

  So first of all, with BRCA carriers in particular, they're at risk of breast cancer and ovarian cancer. So you remove the ovaries physically in the tubes. You're, you're dramatically lowering your risk of ovarian cancer. It doesn't matter whether we give you the hormones back there. And what's so fascinating, and we can't explain this necessarily, but you remove the ovaries, you actually also lower her breast cancer risk, even if she still has intact breasts. Um, many of these women will have a prophylactic mastectomy. But what the studies have shown is giving back hormones.

• 54:32Dr. Mary Claire Haver?

  Doesn't negate the risk reduction in breast cancer.

• 54:36Speaker 00

  Ha, we don't know why. That's another question. But it's really interesting. So basically, the guidelines are actually quite clear. This is NCCN guidelines as well as ACOG. Menopause Society is that if you are a BRC pre-vivor, meaning you've not had cancer, you've removed those ovaries, whether you've had your prophylactic mastectomy or not, you can and really should have those hormones given back to you up till at least the age of natural menopause, when you can have that same discussion that every average age menopausal woman has about, what do you want to do now going forward?

• 55:10Dr. Mary Claire Haver?

  Yeah.

• 55:10Speaker 00

  And what's really shocking is many of these women have already had her bilateral mastectomies. There is literally no reason to be withholding hormones from them because of all the risks that you were alluding to.

• 55:21Dr. Mary Claire Haver?

  So you did a study, you co-authored a study, and you found that 94% of breast cancer survivors report moderate to severe menopause symptoms, and 89% felt that the care was inadequate. How groundbreaking was that?

• 55:36Speaker 00

  With my co-authors, Dr. Leila Agrawal and Dr. Eleanor Tiplinski. And this is the positive power of social media, right? So we did a study looking at, we called it WISH, Women's Insights in Sexual Health Breast Cancer. So what kind of information were they getting in access to care for their sexual health concerns after breast cancer? We focused a lot on sexual dysfunction, GSM. We asked a few questions about, like, their menopausal symptoms as well, other menopausal symptoms. And within three weeks, we got over 1,800 people who completed the survey. Normally, it takes months and months and months to recruit that many people. But we had this outpouring of participation, and the results were profound, you know?

• 56:21Speaker 00

  85% said that they had significant, moderate to severe, impact on their sexual health. And almost 90% said it caused them moderate to severe amounts of distress, which is important. So the dysfunction was there and it caused them a lot of distress. And close to 80% says it greatly impacted their relationships with their partner. And we allowed patients to make a comment to all the questions. So we have literally thousands of comments on their experiences. And it is, I like to call it shock and awe. So we were really proud to present it at ASCO and it got published because we really want like this to be a wake up call.

• 57:04Speaker 00

  Right. It wasn't actually surprising that women had these things. But I think it was jarring to see how explicit they wrote about how much it hurt them and how little information they got. Like basically, nobody got referrals, nobody was offered all the things. Cause it's vaginal estrogen, yes, but there's a lot of things we can do for sexual health. Basically, they weren't getting much. Yeah.

• 57:29Dr. Mary Claire Haver?

  I'm going to call myself out here because you fixed my semi-broken vagina. You know, we're friends, we talk quite a bit. And I was on HRT early in the game. Within nine months of when we figured out it was menopausal because I was on birth control pills. I came off, I was immediately off hormones and figured out, oh God, my ovaries quit somewhere back there. And here we are. But I never started vaginal estrogen. I wasn't having any symptoms. So I thought I wasn't having much dryness or anything. And I was like, well, when I get there, I'll get there because I often prescribe them together. But I never thought about prophylaxis. Like, why would I wait till something breaks? But I was, we were chatting and I was symptomatic because I was struggling with orgasm.

• 58:12Dr. Mary Claire Haver?

  I was literally like, why is this taking so long? Like this used to not take so long. Like I am frustrated here. And you know, trying all the different techniques and different vibrators. And you know, we go to these conferences and they're throwing vibrators at us. So I feel like I have to try them all so that I can talk to patients about the different methods. And I'm like, this is taking forever. And Corinne just casually goes, I think we were texting. No, we were on.

• 58:36Speaker 00

  You guys, you're like, girl, I don't know what's going on with it. I said, Mary Claire.

• 58:40Dr. Mary Claire Haver?

  How much vaginal estrogen are you on?

• 58:42Speaker 00

  You are an issue. I was like, I'm gonna out you on social media that the menopause queen isn't using vaginal estrogen.

• 58:48Dr. Mary Claire Haver?

  Me, me, the woman who talks about this stuff all the time. And then really, within a month or two, everything was kind of back to normal. So, thank you.

• 58:56Speaker 00

  You're welcome.

• 58:57Dr. Mary Claire Haver?

  My distress is much lower.

• 58:59Speaker 00

  Yeah.

• 59:00Dr. Mary Claire Haver?

  And now I, you know, if I lay off, I immediately have urgency and frequency and stuff. So like, that keeps me on track.

• 59:08Speaker 00

  But it's interesting that you mentioned like the decreased or, you know, diminished orgasm or like it's harder to orgasm. It's because this is the one area that we don't say it that much with GSM. It is clitoral atrophy, people. You don't atrophy the vagina and the vulva and the clitoris stays robust.

• 59:26Dr. Mary Claire Haver?

  Just magically.

• 59:27Speaker 00

  Yeah. And also like, and our friend, Dr. Rachel Rubin is always like saying that like, guys, like vaginal estrogen is like Viagra for women in terms of, it's not exactly the same, but the idea is Viagra brings blood flow to the genitals and that's what vaginal estrogen does. And blood flow is a clitoris's best friend.

• 59:44Dr. Mary Claire Haver?

  So, did you ever imagine that in all of this, you'd be a medical communicator? Or influencer, as some people like to refer to us?

• 59:51Speaker 00

  No, we're, we're, we're thought leaders. We're medical experts. We're medical educators and we are medical communicators because I'm not in the clinic doing like seeing 30 patients a day anymore. And God bless, and I'm so grateful for my colleagues who are on the ground providing that excellent care in this very, very broken medical system that does not value patients and it doesn't value doctors either. When we complain about what's happening out there with women getting information or getting menopause care, I, I don't want the doctors to feel attacked. We get it. We understand.

• 1:00:25Dr. Mary Claire Haver?

  We did that job.

• 1:00:25Speaker 00

  We did that job and, and we, we need you to do that job. And so we're trying to educate patients so that they're more empowered so that when they get to you, you don't have to spend an hour explaining the difference between transdermal estrogen and that vaginal estrogen is safe, right?

• 1:00:39Dr. Mary Claire Haver?

  The day that we're recording this, you posted a video that I shared and it was a very, very popular. Medical influencer, medical communicator, Dr. Mike.

• 1:00:48Speaker 00

  Yeah.

• 1:00:49Dr. Mary Claire Haver?

  And he was speaking on a panel at a large

• 1:00:52Speaker 00

  Yeah.

• 1:00:52Dr. Mary Claire Haver?

  Uh, conference. So tell me, and you reposted it and, and, uh, do edit it and you put in your thoughts

• 1:00:58Speaker 00

  Yeah.

• 1:00:59Dr. Mary Claire Haver?

  About it. Let's go through that right now.

• 1:01:00Speaker 00

  Yeah. So I, I just

• 1:01:01Dr. Mary Claire Haver?

  Cause you just got back from a big conference where something similar had happened.

• 1:01:04Speaker 00

  So, yeah, Dr. Mike was on us, this panel and they were talking about the role of how do we communicate health messages to the public?

• 1:01:13Dr. Mary Claire Haver?

  Yeah.

• 1:01:13Speaker 00

  They were talking about it in the framework of what happened with COVID and public health officials and doctors and communicating to the public. So that was the theme. But then it kind of got a little bit deeper and kind of talking about what does the role of social media play? And what is the responsibility of people whose job it is to tell people information from a public health standpoint, um, or, or anything? How do you communicate? And there is a tension in this world now between, um, the people who are publishing and in the research and the people who are on the ground doing the really hard work in the clinics. And then the people who are out there publicly facing and talking to people on social media. Right? This is the new newspaper. It's, you know, it's the new radio. It's the new this and right? It's not going away, but people are a little uncomfortable with it. Right?

• 1:01:58Speaker 00

  And I get it. It's very, very frustrating as a doctor and we see it too, that there's a ton of misinformation out there, a huge amount. And I can't imagine being in that clinic every day and having patients say, look, I heard this, I heard that, I heard that. And I get it. And sometimes it can make you roll your eyes when you hear, oh, you heard this on social media. Okay, great. Right? But that can be a bit dismissive to the patient and it can be a bit dismissive to the colleagues who are out there. Like it's hard doing this. It's a lot of work. I do it because I love talking to people on social media about being empowered because I lived all these things. If you listen to my reels, it's, I'm very emotional about it. I really believe what I'm telling patients. And it, it, it's work. It's, it's my role that I'm giving back

• 1:02:41Dr. Mary Claire Haver?

  Yeah.

• 1:02:42Speaker 00

  To the medical world. But what I see sometimes at medical conferences or, you know, within these professional societies is a little bit of a roll of the eyes. Oh. The Dr. Influencer, which I don't, yes, we have influence, but I'm not an influencer like someone who does not have any medical training. I'm actually a medical expert who's communicating. That's why I like to call ourselves medical communicators, right? And so Dr. Mike was talking particularly about something with the AMA and some kind of messaging that they sent out in rebuttal to some public health information that wasn't right. So he said the AMA sent out a strongly worded tweet that got 5,000 views.

• 1:03:24Speaker 00

  And he's like, and then they put their president on camera with a webcam that was like, didn't work well and the microphone was not great. I'm like, no, no, we have to be better at communicating because this is the world. Right? And so when people roll their eyes and be like, oh, you probably heard that on social media. Or, you know, some doctors on social media are talking about progesterone or talking about that women should consider, you know, menopausal hormone therapy for XYZ. We can't be dismissive of our colleagues who are out there. We should build bridges because I love to bring the research to the public. Like, I'm not doing all those research studies. So I love to read them and then communicate them to the public.

• 1:04:07Speaker 00

  So I'm grateful for them for doing the research.

• 1:04:10Dr. Mary Claire Haver?

  Yeah.

• 1:04:10Speaker 00

  I want them to be grateful for us.

• 1:04:11Dr. Mary Claire Haver?

  It's almost like a translation service. We do backdrops of the studies behind us to like, share the new information that comes out. The new guideline updates, anything we think would would enable a patient to make a better informed

• 1:04:24Speaker 00

  Yeah.

• 1:04:24Dr. Mary Claire Haver?

  decision for herself.

• 1:04:25Speaker 00

  And I think some physicians, and I hear this, are just like, oh, my God, I feel so like stressed that, you know, I have to get up there and do that on social media. I'm like, no, girl, you don't gotta do that. You could reshare stuff. You can give a little list of the doctors that you really like in your specialty that speaks to your patient's concerns. And say to your patient, I don't go on social media, but here are the accounts that I think are providing high quality information. Tell your patients that. Or if you are on social media and have a big account, it's okay. Just reshare other good content. Direct your patients to credible sources.

• 1:04:58Dr. Mary Claire Haver?

  Right.

• 1:04:58Speaker 00

  And be careful about battling in the comments misinformation from people who are not experts who don't.

• 1:05:05Dr. Mary Claire Haver?

  So much of it is bots.

• 1:05:07Speaker 00

  No, because you feed and you give that person more power when you, attention. Better is to shine light in the darkness. So lead with good information or direct your patients to the people who are giving good information and together us physicians can drown out all the crap that's going on out there.

• 1:05:26Dr. Mary Claire Haver?

  We've got some pre-vivers, we've got survivors, you know, a lot are going to be listening to this. What are some top resources for them? What would you recommend?

• 1:05:34Speaker 00

  So if you are a breast cancer survivor, listening to this, my favorite source is menopauseandcancer.org because she has information on managing all aspects of menopause and cancer because it's not just breast cancer. It's colon cancer, it's cervical cancer, it's ovarian, GI and cancers, lung cancer. There's lots of women out there dealing with that. She's an amazing source. She has physicians, she's got a podcast, she's got a book, tons of free resources, nonprofit. That's one of my favorite. If you're young and just diagnosed with breast cancer, the Young Survival Coalition, of course.

• 1:06:07Dr. Mary Claire Haver?

  Any books?

• 1:06:08Speaker 00

  I do like this one book called The New Menopause.

• 1:06:10Dr. Mary Claire Haver?

  No. I don't do a lot of, I don't cover a lot. I always refer out, you know, for survivors because that's a whole nother book, you know?

• 1:06:19Speaker 00

  Yes.

• 1:06:20Dr. Mary Claire Haver?

  It's so nuanced.

• 1:06:20Speaker 00

  Yes, but no, no, I think it's really, really important for women.

• 1:06:23Dr. Mary Claire Haver?

  I'm manifesting your book for you right now.

• 1:06:24Speaker 00

  Oh, well, thank you. But I, I think it's really important that women actually understand the basics of what's happening from a hormonal standpoint. Put the HRT question aside for a second. Like you have to name the problem and understand the problem, understand the physiology so that then you can say to your healthcare team, okay, doctor, I understand why I need to do a hormone blocker or have my over removed or whatever the case is. So how are you going to then address the estrogen deficiency? The British Menopause Society has a very lovely guideline called the management of estrogen deficiency in breast, you know, breast cancer survivors. And it's a really simple checklist of all of the things. One

• 1:07:09Speaker 00

  of the leading things they say is that women should be referred to a menopause specialist preemptively. Get them involved early. That's not happening. Let's face it. So you need to take charge and, and really say like, okay, I'm going to do these things, but you need to support me. With all of my body systems on how that's going to be impacted by this menopause.

• 1:07:32Dr. Mary Claire Haver?

  So hormones are off the table for her. What are some of those resources? We talked about vaginal estrogens. We've covered that.

• 1:07:39Speaker 00

  Yeah, vaginal estrogen, of course, if you have vasomotor symptoms, hot flashes, night sweats and insomnia, you must address it. I know many people don't want to take another medication. And there are some, you know, you know, yes, you could sleep in a cool room in layers. I get it. But you know what? If a medication and there are non hormonal medications, both off label medications, as well as specific FDA approved medications, the guidelines are clear on that. The menopause society has a whole list of the non hormonal evidence based approaches. You must do that. Don't try to ride it out, stick it out. Because if you are not sleeping at night and your quality of life is poor, it is very, very hard for you to do the lifestyle pillars of nutrition and exercise

• 1:08:22Speaker 00

  and sleep and community and, you know, your mental health and all of those things. So, you know, my friend, a new friend, Dr. Shannon Klingman, who created Lumi, she's an amazing entrepreneur, physician.

• 1:08:36Dr. Mary Claire Haver?

  She's incredible.

• 1:08:37Speaker 00

  And she is now fighting breast cancer. And so she's gone public with it and I've helped her with things. And she was on HRT, living her best life and she loved it. And listen, I love HRT too. Like, we want to prescribe it to the people who we can prescribe it to. But right now, she's having to use an aromatase inhibitor. And so she says, you know what? I am feeling better than I ever have in my life. Because when I was taking my patch, which I did love, it gave me in some ways, a little false sense of like health. Where she's like, I wasn't leaning into the lifestyle pillars, which you and I always preach about. It has to be non negotiable. Non negotiable. The HRT is like a nice ingredient, but you've got to do these other things.

• 1:09:18Speaker 00

  And so she goes, now she's exercising and doing all these things like her life depends on it. Because she says it is. And she says, I feel better. I'm stronger. I have more muscle. My bone is going to be healthy. I'm sleeping better. I'm eating a cleaner diet. I've gotten rid of alcohol. She feels great. So I tell patients, I know that it's a lot of pressure when you've. Just been hit with all these treatments to be like, oh, I've got to become like this superwoman now. No, I say, but you could take like one brick off your back, like I was alluding to. So you could say, okay, well, you know what? For the next three months, I'm just going to eat clean. Or the next three months, I'm going to like invest in that group exercise class or that personal trainer, or I'm going to speak to my nurse practitioner or my medical oncologist about getting something for those hot flashes.

• 1:10:01Speaker 00

  Because then we slowly piece everything together and we can really improve your quality of life. And then there's some women, and the conversation's moving forward, there are some women within this breast cancer survivor world who may consider menopausal hormone therapy in the future. Sometimes it's not right for them at that time. Sometimes it's never right for them. But there's subsets of them who might consider it because breast cancer is not one disease. It's heterogeneous. Each cancer, you can't lump a DCIS, someone who had DCIS and a mastectomy.

• 1:10:33Dr. Mary Claire Haver?

  Or what they call stage zero.

• 1:10:34Speaker 00

  Yeah, with someone who has more advanced breast cancer or someone who is triple negative and we never shut down her ovaries before. So like, why can't we talk about hormones? Well, we can. So it's opening up. There's a paper being published in January that's talking about a trial that we're going to hope support worldwide called the Menn ABC Trial, where they're going to enroll women who are breast cancer survivors and collect observational data about their outcomes. Dr. Larkin and a team had a wonderful editorial in the Menopause Society Guidelines Journal. And there was just recently a practice pearl by Dr. Holly Peterson about how we need to approach this difficult conversation because there's more than four million women in the US alone. These women want some answers.

• 1:11:19Dr. Mary Claire Haver?

  So how would you advise a partner, if they're listening, to be supportive and lean in? Because women take on all these roles, right? Mother, cook, organizer, head child, you know, whatever. And then all of a sudden. They get these diagnoses and they have to pull back from all those other roles. And someone has to step up to fill the gap.

• 1:11:45Speaker 00

  It's a huge burden on the partner in your life, your husband, your wife, partner, because they do often have to take on other responsibilities. But if they really want to be supportive of some of the collateral damage that's happening, I'm going to really beg them to like, get educated. Like, you gotta know what's happening to your, to your, you know, the woman in your life. You have to understand, like, she may not want to have sex with you, not because she doesn't love you, but because it hurts, or because it's just less, it doesn't feel as good. And so her brain doesn't want it as much. Or maybe she's so exhausted because her hot flashes are keeping up her at night that by the time she hits the bed, she's not thinking about sex. She just wants to try to desperately go to sleep. Or if her muscles are hurting, or joint pain, or all of the menopause symptoms.

• 1:12:27Speaker 00

  So get educated, read a book like yours, get information, read our friend's book, You Are Not Broken is another great one, because I think it really helps with intimacy and talking about how to communicate when it comes to like maintaining that relationship and that connection. That goes a long, long way. And tell her she doesn't always have to put up such a happy face. I always wore a mask in terms of I had the perfect wig, my makeup was always on, no one knew I had cancer. We kind of didn't tell a lot of people about it. I put up a good, good front and I didn't have to. So tell her it's okay for her to be a little vulnerable and break down sometimes. And guess what? When chemo ends, that's when the sadness and the grief sometimes kicks in.

• 1:13:10Speaker 00

  Because everyone's like, you're done, yay, pink ribbon, let's go on like a 5K walk. I'm like, no, I can't be around this, this is depressing. I'm, I have so much fear of recurrence and all the collateral side effects. And people don't realize, women are in breast cancer treatment for years. It doesn't end when the hair grows back.

• 1:13:27Dr. Mary Claire Haver?

  How old was your mom?

• 1:13:28Speaker 00

  My mom was 54 when she died. And we were, we were born on the same birthday. So next, next December, I'll be 54.

• 1:13:36Dr. Mary Claire Haver?

  Yeah.

• 1:13:36Speaker 00

  Which is, will be 25 years.

• 1:13:38Dr. Mary Claire Haver?

  And that's a big day for you. This is 57 and the year I outlive all three of my brothers who died. So I get it. But you do say that the last third of your life should be the best third.

• 1:13:50Speaker 00

  Yeah, it only gets better.

• 1:13:51Dr. Mary Claire Haver?

  And you're. Great relationship, healthy kids, thriving. You've got this incredible career that you've

• 1:13:58Speaker 00

  New direction.

• 1:13:59Dr. Mary Claire Haver?

  Pivot and you're teaching. You've got this incredible following community and it's just such an inspiration, I think, to our, our listeners. So, so much in menopause is, is expecting women to be quiet and to fade away and to become invisible. But unpause is about really taking the reins back on this part of our life. What are you unpauseing in your life?

• 1:14:22Speaker 00

  Hmm, what am I unpauseing?

• 1:14:26Speaker 00

  I think this part of my life has given me now this freedom to kind of finally really focus on myself, my development and let, let my wings fly. Like I let my birdies fly. They've flown the coop. They're always welcome back to the, to the nest, of course. But I'm, I'm unpauseing, you know, worrying about everybody else and focusing here and, and leading, right? So that my daughters won't have to face the same struggles in accessing quality health care and making hard decisions in the women's health space because no one has it easy. Sometimes I look back and think like, why me? Why, why did this happen to me? I went through so much.

• 1:15:11Speaker 00

  But now, when I talk to all these women out there, every woman is dealing with their own challenge. You don't, you don't know until you walk in her shoes. We're all at some point in our life as a woman, going to have to deal with something difficult within our health, right? And so I'm excited to empower women to not have to face the barriers that we all had to face.

• 1:15:30Dr. Mary Claire Haver?

  Well, thank you for coming on Unpause. We loved having you.

• 1:15:33Speaker 00

  Thank you for having me. Menopause made me do it.

• 1:15:37Dr. Mary Claire Haver?

  Oh, she gave me this button.

• 1:15:38Speaker 00

  Yeah, menopause made me do it.

• 1:15:39Dr. Mary Claire Haver?

  Menopause made me do it. It's my new mantra.

• 1:15:42Speaker 00

  Thanks, Mary Claire.

• 1:15:45Dr. Mary Claire Haver?

  As a reminder to our audience, you can find out more information from Dr. Men at her website, drmenn.com, or you can follow her on Instagram, TikTok, and Substack at DrMenOBGYN. For more information, check out her CME course, Managing Menopause and Breast Cancer, at heatherhirschacademy.com. 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 DrMaryClaire and get honest, accurate information on health, fitness, and navigating midlife at thepauselife.com. Also, my new book, The New Perimenopause, is currently available for preorder on Amazon. If you're loving this podcast, be sure to click Follow on your favorite podcast app

• 1:16:28Dr. Mary Claire Haver?

  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. 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. 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.