The #1 Menopause Doctor: How to Lose Belly Fat, Sleep Better, & Stop Suffering Now

hey I'm so glad you're here I promised you I'd be in the studio today Shay all day she's here too you can't see Maddie but she's right behind you so we are about to have the amazing Dr Mary Claire uh Haver jump in that seat and I just want to tell you this is going to be one of those episodes that's going to change your life and it will change the life of every girl and woman you know so please share it share it share it are you ready you ready to start the Mel Robins podcast I know you are me too don't forget to subscribe Mah let's do this we were living Our Lives managing our stress managing our weight doing all the things and then all of a sudden you can't put your finger on it but something's changed that's exactly what everybody says and whether this is happening to you or you've heard your sister or your mother or your partner say this we start going my my pants are not fitting I am grouchy suddenly I feel like I have ADHD or brain fog or dementia I don't feel like myself in my body you are every single who comes to my office this exact same [Music] story hey it's Mel and I'm so glad that you're here today whether you're listening for yourself or because someone that you loved shared this episode with you I want to welcome you to the Mel Robins podcast family and thank you thank you for making this podcast one of the most popular podcasts in the entire world it is an absolute honor to be able to spend some time with you today and I want to start by acknowledging you for something you could be listening or watching to a bazillion things right now but you chose to take some time for yourself and listen to something that can help you create a better life and today holy cow is that going to happen because we are digging into a topic that is impacting nearly 1.2 billion people it also happens to be one of the most requested subjects that you've been asking me to cover and one of the reasons why you want me to cover it is because there is so much confusion so much conflicting information about this subject what am I talking about menopause it is time that you feel informed about what's going on with your body your brain and your hormones and if this is not impacting you personally do not change this listen because it is impacting someone you love oh I have been dying to have this conversation about women's hormone health and menopause with you because I got to be honest with you every single friend of mine has been texting and dming each other we are lighting up the group chats I am no longer sending my friends memes and funny quotes right now you know what I'm sending them articles about hormone changes articles about supplements I've been complaining to my poor husband Chris about how bloated itchy irritated I am I'm confused about what to do and you know what this approach is not helping Chris to understand me it's not helping me to understand the changes that I'm experiencing and I'm sharing this with you because if you're overwhelmed by the topic of hormone changes or menopause or you're experiencing challenges with your monthly cycle or maybe you're just tired you're tired of hearing your mother or your significant other complain about the changes in her body boy oh boy are you about to learn a lot one of the reasons why so many of you feel so powerless about your hormones is because your doctor is probably not informed about this topic either so you're not getting the answers the information and the simple things that you can do that you deserve well that changes today because your friend Mel Robbins has tracked down one of the leading Specialists on menopause and estrogen deficiency she has hopped on a plane from Texas and this woman is so busy I cannot believe she's taken time out to be with you and me here in our studios in Boston she has come to share with you everything that the research says and more importantly the simple things that you can do and there's a lot that is going to surprise you today for example didn't know param menopause can start as early as the age of 35 and you know I know that hot flashes and belly fat are symptoms of hormone changes it's probably just the symptoms that I complain about the most but current research is finding that things like ringing in your ears frozen shoulder I didn't even know that was a thing dry skin dry mouth body odor anxiety fatigue lack of a sex drive autoimmune diseases and on and on can all potentially be tied back to the changes your body is experiencing because of menopause I am so honored for you to meet our expert today because she's going to simplify this topic so that you no longer feel overwhelmed and left behind by the medical community but rather you feel empowered and excited about what you can do so let me tell you a little bit about Dr Mary CLA Haver she is a board certified Obstetrics and Gynecology specialist Dr Haver is also a certified menopause practitioner from the menopause society and you're going to learn why that's actually a very big deal a little bit later in our conversation she's also a certified culinary medicine specialist from Tain University a best-selling author and author of The Incredible brand new book the new menopause she's the founder of the maryclair wellness clinic which is dedicated to the care of menop pusle patience and this is really important she has two kids and just like me she's 55 she's juggling a big career a marriage and motherhood and she has so much to share with you today that you will be able to apply to your life as you're listening as soon as you're done and I want to remind you this is not just for you please share this with every single woman that you know because what you are about to hear will change your life and hers without further Ado please please help me welcome Dr Haver to the Mel Robbins podcast thanks for having me thank you so excited to be here and share all things menopause you are so passionate about this topic and you even get very emotional about it when you think about it why are you so passionate about this because in my own journey of going through menopause and realizing what a gap there was in my own training and how I really wasn't the best menopause provider for a long time uh I have such a need to get out there and teach and share because we are not teaching our medical students and residents in you know our nurse practitioners much about menopause care outside of the most cliche of symptoms and how to manage them we're going to live a third of our lives like this a third of our lives like this a third of your lives and you know after reproductive options are taken off the table it's almost like medicine leaves us behind I want to be an 80-year-old climbing that mountain kicking ass having a career healthy and if I don't Implement changes today I'm not going to be able to reach that goal so why is it that there is so little information about hormone changes and menopause and you go to your doctor and it's sort of like oh well you're going to deal with this for about 10 years and then you know that's just the way that it is what what is up with this so if you go to PubMed which is basically Google for healthcare professionals um which is where it's like a repository of medical studies and you put in the word pregnancy you'll get about 1.1 million articles all important great stuff right it's important that we have healthy pregnancies and we deliver children in a healthy way and Etc when you put in the word menopause we get 94,000 articles we only get 10% of the funding that means 10% of the brain power 10% of the research for the last third of our lives and you know we do live a little bit longer than men but we're going to spend 20% of that in poor health in decline in disability and this is avoidable I hear the word menopause and I think out to pasture right you're done and I thought that for a long time too and then I'm Gen X you know what to hell with that I'm I want to live a good life I want to feel like I can go to the gym I can play with grand babies I can roll on the floor I can climb a mountain I can run a company I can do all these things and I'm not I'm refusing to just accept the medical definition of getting older for a woman which is very different than a man so when we're born we have about a million plus or minus eggs so from birth until you know we die we're slowly losing that egg count and it starts accelerating as we get older so by the time we're 30 we're down to about 10% of our egg supply well hold on a second by the time you're 30 mhm you've already lost 90% of the eggs that you were born with that's correct I don't know why I never knew that I I I kind of feel sort of dumb that I've gone through 55 years of my life and I did not know that we're down to about 10% and at 40 3% 3% at 40% mhm wow yeah and you lose your period because you have no more eggs so there's no more need to go through you can't ovulate so yeah there's nothing but doesn't it make sense now of course it makes sense why it's harder to get pregnant when you're older why you're more likely to have a chromosomal abnormality you know because the number and quality of your eggs is declining with age what happens for females is that our endocrine system especially the ovaries age at twice as fast a rate than the rest of our body the endocrine system is where our hormones are created okay all of our estradi our progesterone about at least half of our testosterone is created in those ovaries every single month every single day however when we get to per menopause things start changing and when we get to full menopause we have no eggs left the ovaries decline we're losing our ovaries at the average age of 51 they stop producing sex hormones and we basically are forced to live the last third of our lives without the benefit of estrogen progesterone and about half of our testosterone I get this at a level that I've never understood this before because when you really just put it in the context of you're born with a million eggs and from the moment you start your menstrual cycle and the hormones are going up and down there is a purpose associated with the design of your body and once that stops everything gets disrupted correct your body oh why has nobody studied this what the hell people are studying it um you know when we look at OBGYN The Residency women yes I'm OBG Women's Health super proud of what I learned in my training right pediatric gy you know Gynecology Oncology surgery babies fertility all this stuff minipa got shoved in this tiny little box like she's going to have a few hot flashes and maybe some vaginal dryness her bones might get a little weaker and and that's it we only want to give her estrogen if she can't tolerate anything else if nothing else is working then fine give it to her but you know you might kill her wow wow our bodies thrived on this hormone right for 50 years 51 years on average by this hormone you mean estr estrogen and testosterone and progesterone you know like we were we were living Our Lives managing our stress us managing our way doing all the things and then all of a sudden you can't put your finger on it but something's changed that's exactly what everybody says and whether this is happening to you or you've heard your sister or your mother or your partner say this we start going I'm doing the same stuff I've always done like my my pants are not fitting I am grouchy suddenly I feel like I have ADHD or brain fog or dementia I don't feel like myself in my body you are every single patient who comes to my office this exact same story what would you as a gynecologist do when a woman would come in as they did for years and years and years before you became one of the world's leading experts in this what would you do as a doctor I'll tell you a story from my training so we had Gynecology clinic in residency and I was an intern and so um we had you know OBS divided into two sections and so in gy clinic we had you know the surgical cases coming in and so all the residents would line up like six or seven of us and the upper levels would run for the surgery cases cuz they want to operate right and US interns would be left with whatever was left and they'd be like oh you got a ww a ww a ww in room 12 good luck with that and a ww this wasn't written in the chart my professors never said this this was kind of lore handed down from upper level res you can do it with a Texas accent cuz that's where I trained so these guys in cowboy boots walking up and down the hey you got a ww in room 12 good luck with that you know and it met whiny woman so here was this woman coming in and this was a public health hospital you know so she's desperate she can't sleep she's gaining weight she's not happy she's having maybe headaches I mean just this kind of laundry list of very vague complaints but she was still having periods yes maybe IR regular maybe heavier maybe lighter maybe you know and and just this and you were like h it's just part of aging if she came in complaining of libido I was a deer in the headlights like I didn't know what to tell her like we were taught nothing about the female sexual response or medications that might help or you know go out and have some wine relax get a new boyfriend you know all the other complaints I would start sending her to other Specialists like let's go see a cardiologist for the palpitations and the you know um neurologist for your headaches and the you know and she'd walk out of my office with six referrals and I didn't know enough to say let's try some hormone therapy and see if these things get better I'll do some blood work let's make sure it's not autoimmune disease or hypothyroidism I was doing that I just think back on that and that we can do so much better we got to do a better job training every single Healthcare professional in all Specialties about how special menopause is and what the lack of estrogen is doing to each and every organ system each female has a unique expression of our menopause so where you may have had palpitations for frozen shoulder and dry vagina I would have had hot flashes night sweats and horrible rage and you know doctors like a checklist of symptoms it's how we're trained recall you know but the you know we're trained to look for ducks how does it does it walk like a duck talk like a duck it's a duck and everyone's Duck's a little bit different you mentioned that every organ in a female body yes every organ system yeah every organ system has receptors or has what for estrogen that's where the research is really exciting right now is that Duke University did this elegant study looking at frozen shoulder which is adhesive capsulitis so common in women especially in menopause and she a woman finally a woman head of a orthopedic surgery Department talked to the woman head of an OB gen department at a big university and they're like something a't right and they did the studies and they showed that women on hormone therapy have a lower chance of frozen shoulder they pulled all the data they look and they're like why would that be so then now they're going in and and doing biopsies of all these joints and saying there's tons of estrogen receptors here and when we lose that estrogen we're seeing Mass it's a it's an anti-inflammatory hormone in the bones and joints so we have arthralgia joint pain capsulitis all of this stuff tremendously flares and some of your listeners were like oh my God right now I had frozen shoulder so really really common or hip pain or joint pain or you can't roll over in the bed it's so painful and you have no injury wait I I'm sitting here feeling one revelatory oh my God oh my God oh my God like there are there are times in bed where I am laying there and I will go to roll over and it's as if I have to pry myself over I'm so stiff wow that makes so much sense actually so if the estrogen receptors are in your organ system that then presumes that it's impacting liver function kidney function everything lung function heart function brain function genital urinary function as we know bones osteoporosis we've known forever that's a that's a no-brainer wow and so I want you as you're listening to Dr Havert to just really think about this for a second that every single aspect of your organ system from your brain to every organ to your muscles all of it is used to functioning with estrogen it makes so much sense if you take out one of the main ingredients to the female body's Optimal Health of course everything is going to go Haywire mhm Dr Haver I just am so grateful that you're here and I want to take a quick moment we got to hit the pause uh in menopause and hear a word from our amazing sponsors and please take a listen to our sponsors because they are allowing me to bring you Dr Haver at zero cost so take a listen but don't you dare go anywhere let me tell you why Dr Haver and I are going to be waiting for you after this short break stay with us welcome back it's your friend Mel Robbins and I am here with the remarkable Dr Claire Haver her new book is the new menopause and she is an expert in women's hormones health so you've now got this estrogen deficiency well it low not zero menopause is zero but still but I'm saying so so I want you to pay attention to what Dr Haver is about to explain to you because your body has been experiencing mild symptoms of this for your entire life you just probably thought it was whatever but this is the symptoms of a drop of estrogen how is estrogen helping your body and your organ system run in the most optimal way efficient manner okay so the first you know half of our cycle so you have a period you know the first day you bleed is day one of your cycle so you're kind of that's you're shedding and starting over so in those first 14 days we call that the fic phase so that's when our follicles which are the little sacks that our eggs sit in start saying okay one of us is going to win so 100 200 of them are like it's a race the hormones are starting to okay you know the brain's like our estrogen's low let's go let's go estrogen starts to rise and then that lining starts to thicken up again getting ready for a potential baby then we hit about day 14ish depending on the cycle and then the estrogen level is at its highest okay the brain is like okay we need to ovulate the LH surges and that's that's the thing that makes the egg pop and that one one or two eggs come out and then when the egg pops the popping also creates a little surge of estrogen just a little bit more okay and then progesterone starts being produced where that egg came out from okay that's a really efficient Factory for creating progesterone then that progesterone starts rising in that second half you're very slight but it's there kind of mimicking what's to come when we totally lose our estrogen and so in the second half of this month and this cycle as the estrogen starts decline what happens in your body so we have a some women suffer horribly from it but we have premenstrual dysphoric disorder pmdd bloating swelling now we think the bloating and swelling is from the really high progesterone levels that drop of estrogen our mental health changes how does it change our mental health when you have a decline in estrogen so there's a lot of research going on right now but we know that tons of estrogen receptors in the brain and our serotonin is affected how does estrogen and serotonin play so it looks like when your estrogen levels are optimal you know at a nice healthy level we have really efficient serotonin and norepinephrine so those are two key hormones that we see in depression right they're low in dep in women who are depressed and so for women sensitive to it that we're seeing the PMS the pmdd you know those women tend to do okay on a SSRI for a short term they only take it two weeks out of the month or some of them like to take it every month but it really is from that estrogen decline we see menstrual migraine headaches some women with a declining estrogen the blood vessels will slightly um squeeze in in certain areas of the brain which will trigger a migraine headache and so wait a minute so migraine headaches there's menstrual migraines and you also can feel a slump in terms of depressive symptoms or anxious symptoms because of the decrease in estrogen that's what we think and I would imagine brain fog ADHD all of these other neurod Divergent kind of issues that people might have also then see an impact from the decline in estrogen there's a definite pickup worsening with people with known ADHD through the menopause transition per menopause into to menopause and we don't really know if it's a new diagnosis of ADHD or she was kind of making it until per menopause and then because it's a spectrum yeah and then all of a sudden her resilience against this has stopped because she's lost her estrogen her Regester testosterone you know however that fits in for her and all of a sudden she's now so symptomatic and at the time in her life that she needs those facilities to be functioning at all levels you know career women are having leave their jobs we're seeing you know massive economic impact from this in the workforce and you know what I love about the fact that people are researching this is that knowing that it's a neurode Divergent condition and that there are estrogen receptors in the brain whether you're talking about the second half of the monthly cycle or you're talking about the period in your life where estrogen declines that of course you're executive functioning tanks yes of course it makes sense and now the system's going haywire and claimed it's not got the Firepower to help you focus on the thing that you need to do right now wow that makes so much sense I didn't understand the fact that when estrogen declines at all of the symptoms that I was feeling that that has to do with hormone fluctuation what's interesting is if you were to start tracking your cycle which everybody should do MH you would probably over the course of several months start to notice a correlation if not a direct connection between that halfway marker of the month and when you start to feel a little foggier when you start to feel more irritable when you start to feel more bloated you might notice more headaches you might notice which then allows you to be more compassionate with yourself because I think knowing this it will probably put symptoms in the context of how estrogen helps you feel better and what it feels like when your health is more optimal versus these symptoms that come up because when you feel the symptoms you think something's very wrong with me so estrogen's an anti-inflammatory hormone when you doctors say anti-inflammatory I really don't know what you mean and it seems like everything is inflammatory these days and so you have such a freaking unbelievably cool way of explaining things how do you how would you describe anti-in inflammatory inflammatory sure so it's easiest to think about it in terms of acute and chronic inflammation okay acute inflammation everybody knows you got a virus you twisted your ankle you stepped on a nail you you know it's I don't know what that means body's response okay to an acute injury so what happens you you breach some barrier in your body a virus breaches it you know a nail you twist your ankle you have some Orthopedic injury you break a bone okay immediately your immune system goes on alert okay make this stop we need to fix it so it rushes blood flow so things get red and swollen it pumps fluid in the area to try to wall off whatever this Invader is your white blood cells which are in in infection Fighters and and inflammation those are all in pro-inflammatory cells in our body inflammation a code word in medicine for your body is in an alarm state trying to address something yes okay I think I got it and it's all the little biological processes that make that happen so that's acute inflammation right we need that to stay alive bre boom get to workl but then you're healed okay chronic inflammation is when that system gets turned on a little bit you don't it's kind of something not right but it won't shut off so we're so you have this chronic state of of things being chewed up and and laid down and and you know an estrogen kind of calms that process down I think I just got this let me see if I can explain this back to you so chronic inflammation which you said is a sort of like something's little off is that feeling where you're just like something's not right in my body like I just don't feel comfortable in my body but I don't know what it is and it can affect a joint your whole body your gut your head your whatever you know autoimmune disease is basically non-stop chronic and acute inflammation so and and it can calm down a little bit but what that inflammatory process does is chips away at our organ systems well what I'm also wondering is if the female body and intelligent design of the month is designed based on cycles of estrogen in particular and estrogen gets removed either because of menopause or PCOS or changes or surgery or whatever that something to your body's natural process every month of shutting down that inflammation and now your whole body's like something's wrong right we need some estrogen down there and the body doesn't respond can't do it again they're done it's like your whole body's like whoa broken bone something's wrong what are we doing and it races everywhere so in the joints we see arthralgias just this that arthralgia is pain in the joint that sounds like an ugly version of arthritis arthis it sounds like something that you would get in one of these fantasy novel you know the arthis comes over the hill so in the heart let's talk about the heart okay when we get to this like hyperinflammatory State we see palpitations that Sino atrial node so there's a little node there's a little little part of the heart where it sends out a signal to control our heartbeat it's called the SA node sinoatrial node that thing is super responsive to estrogen and likes estrogen and likes it keeps it calm and like beaing in a night thing you take estrogen away all of a sudden some women will start having palpitations out of nowhere wow and they go to the cardiologist they get their million dooll workup and they're like H don't know what's going on and we're not training the cardiologist to say this might be part part of her menopausal picture and you want to know something else that I'm just like actually as my brain is churning and all this is starting to go click click click is that if there's not comprehensive training and if there's not advocacy for what these symptoms are then there's also no health insurance code to cover the cost of a lot of the diagnostic stuff that actually points to what is causing this Medicare does not pay for a menopause visit that's insane right what yeah your wellwoman exam that is devolved into screening for breast and cervical cancer that's it you know that 15 minutes with your legs and stups is not the time to like do a comprehensive menopause visit so you need to schedule another visit you know go in with you're armed with questions go in with your family history and all sounds like don't call it a menopause visit say I'm having lots of symptoms but don't call so it gets covered exactly wow wow okay so the heart the lungs how does estrogen impact inflammatory disease we an increase in asthma and actually asthma that doesn't respond as well to the typical um bronchodilators well that makes sense because it's like an internal system functioning thing where the oil and the gas is no longer in the engine y wow what about like your digestive tract how so the the gut you know the gut health changes dramatically and when the gut health changes and the gut microbiome changes how we kind of reprocess our estrogen changes a bit as well the kind of the metabolism part of it and so you know lots of research going on in that area right now our bones we've known forever osteoporosis now what your listeners may not realize is that osteoporosis is completely preventable for most women and they don't know how we're not diagnosing osteoporosis usually until you have a fracture and 50% of women before they die will have an osteoporotic fracture so just for somebody who's listening that doesn't know what that word means M could you is that like fragile bones bones density what does that mean bone so our bones density maxes out the dent like how thick and strong our bones are the thicker the stronger the more resilient to fracture they are okay in general when and we're constantly remodeling our bones which is why when we and I'll say I'll explain that in a minute which is why when we break them they fix themselves if you line them up interesting so we are constantly chewing up bone like Pac-Man and then pooping out new bone behind it you know really yes and so we're always the bones you were born with were not the bones you had at 10 or not the bones you have at 20 we have totally chewed up and laid down all new bone what happens in menopause or in women with chronic suppression of ovulation chronic low you know postpartum multiple babies we start chewing up more bone faster than we can lay it down and that accelerates in menopause so we end up with this porous bone with holes in it basically that is a lot easier to fracture now if you fracture your hip so if you're 65 plus and that is 10 years away from us and we fall climbing up a ladder chasing a grandbaby hopefully maybe one day no pressure to my children um and we trip we and we we take out a hip even with surgical repair we have a 29% chance of death in that first year and if we I need everybody to hear that this is really serious she's basically saying bone Den starts to decrease based on the decrease in estrogen and aging and aging and that makes you more fragile and prone to having a broken bone and she is also saying this is preventable for most women for most women but if you fall and break a hip at the age of 65 29% of you will die in the first year in the first year with surgery without surgery it's like 79% so they're all getting surgery yeah wow and so say you survive the rest of your life is marked with chronic disability not being able to take care of yourself which is you know my patients don't come in saying I want to rock a bikini they're looking at their mothers they're looking at their aunts and they're like get me off of this path I don't want this yes or they're looking at a really healthy mom who's running around and doing is not for real not decrepit taking care of herself you know and they're like make sure I stay on this path and that's that's where the work begins wow all right we've covered bones mhm what else genital urinary syndrome of menopause okay what is that so that is a big mouthful it used to be called scile vagina that was a medical term cile vagina cile vagina was a medical term yeah it sounds like a GU a bunch of guys got around got really wasted welcome to Western medicine wow in the 1950s then they changed it because it was so offensive to at trophic vaginitis again doesn't sound much better no so our genital urinary system the bladder the vagina the vulva that whole space from your pubic bone to your to the end of your tailbone just all of that area is highly sensitive and highly estrogenized and when that estrogen level drops we lose elasticity we lose so stretchability of the vagina which might be helpful on occasion is that why sex is painful sometimes for most women they have atro atrophic area so they've lost their elasticity they can't make mucus anymore the tissue is thin if you look at a biopsy a premenopausal vagina it's this thick velvety elastic beautiful like bring it baby yes and then this postmenopausal woman who's never been treated it looks like the Sahara Desert you know you've lost layers and layers and layers of tissue it's very dry it's very small and she's just gritting her teeth through through sex and hor uncomfortable I'm a hi and so I've got to use H even with you know systemic estrogen if I don't make sure that area is is well moisturized right things might and also the architecture changes a little bit so things are hanging at different levels and so I love to hike and so I'm going to have some chafing and things that I never had before I need to make sure I'm getting lubrication in that area so I can hike comfortably besides everything else I want to do in that area and this is preventable pre preventable yeah now let's talk about how it can kill you recurrent UTI the bladder health the urethra Health besides incontinence the number one treatment for recurrent UTI in a post-menopausal woman the most effective treatment is vaginal estrogen not chronic antibiotics I'm going to save someone's life by this podcast because I'm going to keep someone from dying from Euros sepsis because she got vaginal estrogen after listening to this podcast this is amazing yeah and it and here's what I love about it it makes so much sense I love how you have explained this to us and I also love the fact that because you've explained it this way and because we've put it in the context of the month and we've put it in the context of your intelligent design and the way that you've always been running or and you know we've all had periods where it hasn't been running optimally that you can also take the information that you're learning right now where we're focused on menopause but you can also go oh I can take this information I can share it with my sister my girlfriend my roommates so that they understand that the second half of their cycle you're starting to experience baby symptoms or maybe they bigger symptoms but that this is all the same might be a precursor to what the bigger picture is kinding yes I am going to send this episode to every single woman I know I am sending this to my daughters so as we take a quick pause hear a word from our sponsors take a moment and share this to people because I want this information out to absolutely everyone because every single woman on the planet every girl needs to understand what is going on in her body and the role that estrogen plays in her overall health you never know you could truly not only improve somebody's life you might actually save somebody's life so we're going to be waiting for you after a short break we're going deeper into the solutions including the three things that Dr Haver says all of you need to be adding into your diet right now stay with us welcome back it's your friend M I am here with the remarkable Dr Haver thank you for sharing this with everybody I know it's making a huge difference to have this information now let's talk about what per menopause is and when it begins sure so I like to start in the middle because there's a lot of misconception around terminology so medically and I think this is a problem menopause is defined as one day in your life one year after your last menstrual cycle yes okay most women know that everything after that is postmenopause so what's perimenopause so perimenopause the best I can Define it is remember we're losing o ovarian function our whole lives from the day we're born however there's a point in time when your body notices so you said that we have only 10% of our eggs left by 30 so is that when it starts so it depends on your body it's when your body is like something's not right it could be mental challenges it could be gut challenges it could be inflammation in your joints it could be irregular periods heavy periods light period No period you know it's really variable how it presents but something has changed nothing in your world has changed something inside of you has changed okay and so per menopause is often defined by irregular periods like in the medical journals but it's a lot more than that it's 7 to 10 years before your period stops so 35 to 45 per menopause is going to begin you're going to start noticing something's not right it could be the cliche symptoms of hot flashes you know why hot flashes Define menopause no because you can't blame it on anything else oh that's true unless it's tuberculosis like nothing else causes a hot flash pretty much unless you have a fever than menopause so that's why it's the heart you know the bell ringer of menopause but what other symptoms might you be experiencing you know arthralgias frozen shoulder joint pain gut dis you know constipation diarrhea you know you name the organ system in asthma flares new asthma new autoimmune disease dry skin dry eyes dry vagina dry mouth it goes on and on and on so it would seem based on the science here that anytime a woman goes to the doctor and has any kind of complaint like that in terms of the symptom that one of the standard procedures should be test your freaking hormones so that's another problem the brain is pumping hormones as hard as it can right and so in that per menopause I call it the zone of chaos yes you're squeaking an egg out now and then but you're having massive surges of that we'll see estrogen levels like you were pregnant with triplets you know three 400 they're temporary because you're you had to work so hard to get that egg out you know and then then it just plummets down to nothing is this why our emotions are all over the place during the month that's what we think that makes perfect sense because if your system is in chaos regardless of your age by the way right but if your system is in chaos because it's having to work so hard to just do the thing TR do the basic biologic function no wonder you start to feel all sorts of things go Haywire MH and so do the same things that you would recommend for a woman who is officially in menopause are those the same things that you should be doing if it's per menopause or it is the estrogen deficient symptoms that you experience in the second half of the month so this is where the art and the science come in and menopause because some women will do well with just some progesterone support some women will need estrogen and progesterone support we don't have a lot of great studies on the best way to support a women's hormones in per menopause so it's a little bit of the Wild West we also we're not teaching our residents IAL students traines how to recognize it how to diagnose it you really I don't need blood test to diagnose per menopause I just listen to the patient and believe her I'm sitting here reacting to everything that you're saying because I'm thinking I don't even really remember anybody talking about per menopause as anything other than your period might get irregular but none of these other symptoms I mean this is very Illuminating and I feel kind of bad that I didn't know that because I had no clue what was happening right I would love to now focus on menopause and are you still in a monthly cycle like what is happening when you're in menopause so once those ovaries fail and I know that term is harsh but you know once the ovarian once the eggs are gone no more periods you will any vaginal bleeding after menopause needs to be evaluated by a gynecologist there might be something wrong okay you should never have another period again so your periods stop or they first they become shorter longer it's really it could be anything but eventually they just kind of stop some women will wake up and never have another period others will have this kind of skipping months and months between until they finally end mine was like Chucky just kind of kept popping up you you know like Oh I thought you were gone yeah and here you are again yes so once you've gone a year then most scientists agree that you're done okay if you're over the age of 45 and you hadn't had a period for a year you are a postmenopausal woman that's the clinical definition and what is the technical definition of when you've moved from per menopause to menopause so Peri to menopause is that one day we're like yep it it signifies your ovarian failure you will never have another egg that's able to be fertilized again okay the end there's no more left okay so and then for the rest of your life you're postmenopausal now some of the symptoms you experience get better it might take several years like the hot flashes do tend to go away the Sleep disruptions if they're related to hot flashes and night sweats do tend to get better might take 7 to 10 years 7 to 10 years I said go away like I'm thinking like might take shorter but I I want to give people a very clear picture and so a lot of women are like well I went through my menopause like I'm done with that and I'm like your bones are still deteriorating your risk of cardiovascular disease is still increased like those your genital urinary system without support is failing and you know these are the things that don't go away in your postmenopause I just realized I'm talking about it wrong because I always say I'm in menopause I'm going through menopause I've hit menopause and you're saying once you actually get to that date where you've had not you've haven't had a period for a year it ain't coming back that's menopause but technically now I'm in postmenopause Forever wow so when you are postmenopausal do you have any estrogen at all so there are four estrog that our body can make the number one heavy hitter most biologically active does the bulk of the work is estradiol and that's what's mostly created in our ovaries okay testosterone can be peripherally converted at a very small rate to some estrad or estrone so estrone is what's created in our fat cells so the heavier the more subcutaneous fat you are the higher your estrone level is which is why heavier women are more likely to have an amral cancer and other estrogen related cancers is this also why one of the symptoms when estrogen starts to decline is that your arms get flabby and you start to gain weight around your stomach because your body once it's signaling there's not enough estrogen being created in your ovaries your body starts to try to create and hold on to it in your fat so there are theories around that the anthropologists are are scratching their heads because there's only five mammals that go through menopod and four of them live underwat beluga whales and a few one of the killer whales yeah really so yeah other mammals on land really that we can figure out maybe one giraffe they're looking at one particular giraffe go we like really unique in that we have a menopause and we think because we've just artificially extended our life past our Evolution with Modern Health and sanitation and all the things that Keep Us Alive that's wild we weren't designed to live this long so we have estradiol that's gone okay the ovaries can't make that anymore maybe a tiny bit but really not clinically significant estrone really weak estrogen okay estol which is created in our placentas when we're pregnant but pharmacologists have been able to recreate it and it's used in like one or two formulations of hormone therapy it's not one of my favorites and then there's this other one called esterol very fancy that the fetuses that when we're in the womb that's another one that we make with fetal cells and that one has also been synthesized and is used in a couple of one hormone replacement therapy I'm that's not one of my favorites no but I mean in your body so your estrogen level is not zero but your estret but it's less than 1% of it was when you were 25 so let me give it to you that way got it less than 1% yeah of what it was when you were 25 holy smokes and your body needs it it will function better with it and you will not die without it you'll just die faster and less healthy and miserable MH wow I'm trying to digest this stat I want to make sure you didn't miss this when you think about the estrogen levels that you have at the age of 25 you only have 1% of that MH when a vestral yeah you are postmenopausal and the only sources for your body to create it are ovaries or a little bit in the periphery you know in other cells you know it that's it wow and our march to death begins not anymore Dr ha because you are here to make sure that does not happen because we are capable of doing simple things to optimize our health and live a long and happy juicy Amazing Life vibrant as a medical doctor as a woman who is going through this right now what do we do now that we know what do we do great question so when I'm have patients come to me in clinic and we talk about menopause care I do it in the form of a toolkit okay we start with nutrition we talk about movement and exercise we talk about stress reduction sleep optimization then then we talk about pharmacologic options like hormone therapy or or if she's not a candidate then other options for her based on her symptoms we also talk about supplements that might be helpful so let's take these one at a time who is not a candidate for hormone replacement therapy very few people actually there's a lot of misunderstanding and misconception around who can and can't take hormone therapy absolute contraindications undiagnosed vaginal bleeding you need to go see your gynecologist you might need an ultrasound or biopsy like if you're having undiagnosed we don't know why you're not bleeding normally please go get that evaluated before we start hormone therapy because it might be a tumor that is estrogen Fed so we need to work on that um active breast cancer shouldn't be on estrogen therapy active blood clot active stroke you know once those six-month markers and and the workout for those things have happened it's a possibility okay it's a nuanced conversation but not an absolute contraindication neither is bre cancer wow there are certain breast cancers that after treatment you know could be a could be a candidate now again nuanced conversation risks and benefits coming back and forth a family history of breast cancer not a contraindication a family history of a blood clot or a history that you have of MTHFR or some of the blood clotting high-risk blood clots as long as you avoid oral estrogen we're not going to increase your clotting risk you're saying that even if you have a history of breast cancer that does not 100% preclude you from having the option gotcha there are ways for you with the counsel of your physician right to explore hormone replacement therapy even if you have so the thing that a woman with breast cancer is most likely to die from yes is cardiovascular disease not breast cancer she's 90% survival cure rate and when we go through menopause we see a dramatic uptick in our risk of cardiovascular disease actually women on hormone therapy if given it that really that we have a w juicy window of opportunity the first 10 years of your menopause estrogen is protective and women on HRT between 50 and 59 is or within those first 10 years have a lower alcohol's mortality a lower cardiovascular disease death death rate and a lower cardiovascular disease at all like death from cardiovascular or or a new a heart attack wow and let me tell you something else blow your mind so primary prevention strategies for cardiovascular disease so women are given statins all the time for high cholesterol has never been shown to decrease her risk of cardiovascular death yes in a man but not in a woman ACE inhibitors a blood pressure medication is often recommended as primary prevention never been shown to be helpful in a woman woman only in men aspirin baby aspirin never been shown to be primary preventative for a heart attack only in men yet we're recommending this stuff to women all the time and we've taken from many women the conversation or the option of hormone therapy is off the table when that is the one thing that is going to decrease her risk besides lifestyle of course wow yeah that's when I get mad I can tell what are we doing I'm glad you're doing something and I'm glad that you're here because when you say like that it's outrageous it makes feel like guinea pigs we are more than our breasts and you deserve the conversation you deserve the option for each woman it is a risk to benefit ratio I don't think every woman is going to choose hormone therapy but I think every woman deserves the conversation based on modern medicine and what we know now can you just quickly say why there is such a hysteria yes yeah around hormone replacement therapy I'll tell you why a beautiful study there's a little bit flawed in the way they set it up because the average age in the study was 62 not 5051 when most women will go through menopause so they did a study that was looking at one just one particular type of hormone therapy primin which is CE conjugated equin estrogens was meant to show that yes hormone therapy is absolutely protective for cardiovascular disease they had two groups women who have a uterus women who have don't and then the women with uterus got estrogen plus a progestogen and then the woman without a uterus got estrogen only okay and they there was a placebo group in each set okay okay and then they started them on hormone therapy average age of 62 and Then followed them and so they were outside the window the hormone really start yes so so when they went back and stratified the data and looked at it so what they said was what it doesn't really help cardiovascular disease well no because it's by the time you're 62 and they had women in their 70s in the study they probably already had it you know so is the bottom line that there was the biggest kind of study that was written about the study itself was flawed and then the reporting became hysterical yes and the kind of lore many of their findings at that hysterical reporting were walked back there's only one that still stands and it's still controversial and this is recently like recently they have literally said that wasn't really accurate it's not really true and so the reason why it's important to say this is because there is this murmur out there that hormone replacement therapy is causes cancer causes cancer super dangerous blah blah blah blah and you're saying there are certain categories where you should not be on but for the vast majority of the women in your life this is an option you need to be exploring yes and it's not only safe it actually increases your health out outcomes so the majority of us are are a safe candidate for hormone replacement therapy what about supplements like what are the supplements that we need to take we really should try to get most of our nutrients from food and we only supplement where there's a gap or you have an allergy and intolerance and then we go in from there there are a few supplements that are non like essential nutrients that might be helpful like turmeric right that's not anything we have to eat to survive but it has some pretty powerful antioxidant anti-inflammatory properties and that some women might find helpful but when we're talking about the things if I had my like top three things I would recommend to everyone fiber track your fiber for a couple of weeks get a nutrition tracker see where you're at fiber does so much in our bodies number one feeds the gut microbiome that's its food so that's the Prebiotic give me example of what like fiber legumes Berry oh legumes so uh n um beans okay beans so it's a class of of beans peanuts are actually legumes as well typically really high in fiber okay um um berries really high in fiber seeds and nuts really high in fiber those are kind of avocado or you know that's my go-to to make sure I'm like getting my fiber go also has healthy fats and other vitamins and minerals and nutrients mag magnesium and this confuses me because I'm not quite sure what type of magnesium to take oh great question your glycinates your Tates your citrates um and etherates are good because they readily absorbed into the bloodstream so now we have nice magnesium levels in our blood there's also benefit some of them are better than others about Crossing that blood brain barrier so the brain protects itself there's a membrane around the brain that it doesn't have this 100% free flow of nutrients back and forth It's really selective about What it lets in so mag alanate which magine or neuromag are the brand names has been studied and like SSRI resistant depression so anti-depressant you know resistant depression in patients added in this it seemed to be helpful it and my patients you know followers it's so helpful for Sleep anxiety so I'm often recommending that one at what one was that one magnesium L3 and8 okay so you're saying Fiers is number one magnesium is number two how do you get magnesium naturally so pumpkin seeds um spinach you know green leafy greens are rich in mag generally I have a lot of list on my website where we list all this we will link to all this and what's the third thing so I'm always looking at omega-3 fatty acids um omegas are usually found in fatty fish also in flax um one of my favorite ways I'll do this little yogurt and I'll have flax hemp and chia seeds so I'm just hitting all my antioxidants my anti-inflammatory my fiber Allin one um so Omega-3s if you can't get a good source of that that's a very reasonable thing to supplement every day one of the richest sources of that is going to be your salmon your mackerel your tuna your fatty fish your cold water fish um and then I check a vitam D level on every woman who'll let me stick a needle ler um 80% of my patients not not just low I mean deficient and there's a million reasons for this we don't absorb it very well because our gut health declines we're protecting our skin from the Sun you know which is another place and we're not really creating it in our skin as fast as we used to so and vitamin D is a hormone that has a million you know processes in the body so I'm like let's start here and get those vitamin D levels up because you're just not working as efficiently as you could a lot of us I've noticed in my uh group chats with my girlfriends that when we finally get in to see somebody who knows what they're doing and you do a blood draw and you get your panels back almost all of us have magnesium deficiency vitamin B deficiency vitamin D deficiency and heightened cholesterol yes so again about 70 80% of my patients have an an explain no changes in diet or exercise rise in cholesterol absolutely secondary to estrogen deficiency and again rushing to put her on a Statin is not will make her her cholesterol go down but is not going to decrease her risk of cardiovascular disease and women who are on HRT have higher hdls and lower ldls than women who are not when you compare the two groups so just being menopausal is an independent risk factor for an un unhealthy cholesterol profile so if you are eating the fiber and the magnesia magnesium and the Omega-3s and you're also taking the vitamin uh D supplement how do you make sure that your body can actually absorb it or that your gut health is okay like do you also recommend that people take a probiotic so I do they've done some studies looking at probiotic supplementation in women with obesity and hypertension who were also postmenopausal and there were some really positive results of you know it's hard to measure gut health you know we don't walk around stool samples and they're counting the microbes in it but you know when you're bloated you know when you're having regular bowel movements you know how you feel when we go through menopause and lose our estrogen the gut microbiome loses diversity no matter how many probiotics you take or you know there are things we can do workarounds but the loss of estrogen will change your gut microbiome to the profile of a man's is that why we get a belly part of it that's part of it um so we know that an independent risk factor for visceral fat deposition what we call belly fat in layman's terms visceral fat means inside the or wrapping around the organs you know inside the abdomen that fat is very different than the curvy fat than subcutaneous fat that visceral fat is a marker for cardiovascular disease diabetes stroke and so women who were on the probiotic versus placebo had lower blood pressure and lower visceral fat weights didn't change you know Cal are still important but they're not the only thing but their visceral fat levels went down so for that reason I'm like eat something rich in a probiotic every day yogurt miso kimchi whatever floats your boat if you can't tolerate that then you want to consider supplementing gotcha talk to us about exercise MH so what kind of exercise is critical I grew up in the 80s and I was the cardio Queen I did so many step aerobics classes I taught them it would make your head spin I did not I can actually see that I would take aerobics class with you it I did all of my exercise was to be thin yep and to maintain a certain body shape that was part of my social currency and if I could go back and talk to my what I tell my children all the time we need to move our bodies to be strong not skinny and that we are chipping away this constant caloric restriction and all this cardio is chipping away at our bone and muscle strength which we are going to desperately need as we age especially if you're built like me y and I didn't pick up weights until I was well into my 40s there's never too late anybody listening at any age can start weight training and you should so I think that getting people to let go of this notion that thin is the way to be and that you're way better off having a little more curves and a lot more muscle is going to serve you in these menopausal years so much better than just being skinny I have followed all this advice and I have switched up the entire way I approach exercise I now resist in strain three days a week um and if you're having a hard time sleeping what do you recommend right so we have to look at why you're having a hard time um progesterone goes a long way to helping us sleep and so estrogen leads to hot flashes and night sweats which are completely sleep disruptive I mean even with hormone therapy I still have a thermometer leg that I have to throw out theter leg I was just talking to a friend this morning she's like oh well I just stick my leg out and the fan hits it and that's how I cool myself down and then throw it back in throw it out throw it back in so I'm like okay let's get you on some estrogen you know and so say she's had a hysterectomy and she doesn't have to have progesterone progesterone is an option so I'm like you know people sleep deeper it has an antic effect what is that word so anti- anxiety anti- anic effect anti yeah sorry wow anti anxiety effect so if your sleep disruption is also H you're having racing thoughts at night you can shut that brain off yes this is my daughter progesterone is beautiful for these women especially in perimenopause when we're skipping ovulations and we're not giving that monthly surge of progesterone is this an option for somebody who's even before per menopause you could yeah yeah you can safely take progesterone every day even if you're premenopausal wow really helpful wow all right so estrogen progesterone but also sleep hygiene we can't negate the fact that we're on our phones too much at night blue light not setting up an environment for good sleep a snoring partner especially some of you know and all the things we need to do to set ourselves up for success for sleep and then when you sprinkle in the hormone changes it's a disaster for some women and that's really something I zero in on with my patients what do we need to know about alcohol I don't know any woman who's in her menopausal Journey who is processing alcohol the way she used to the tolerance seems to be going down I'm excited to see some more research come out about this but in my world like I have to go in my personal experience if I'm choosing to have a drink I am choosing not to sleep I'm going to be up at 3: 2:32 3:31 whatever it is and it is like a bomb going off even one glass and I have to make that choice I can't drink like I used to thank God you know those College days most of the women in my practice and on social media are commenting every time I talk about it they're like yep gave it up it's not worth it if you're choosing to drink you're choosing not to sleep it really is that simple yeah wow so women you know I've said this before we're living longer but we're living in poorer health I I don't want the longer lifespan if I'm going to be decrepit and I'm going to be disabled and I'm my children are going to worry about me every day day I think that you know as my this next gen our daughters come up through this and they have their options and they know what's happening in their bodies and they understand it we're going to keep that lifespan but we're going to improve our health span and make those choices that can lead to us having healthier lives well I think that's like the really exciting thing of this because when you don't understand what's happening you get stuck in the cycle of feeling overwhelmed and that there's something wrong with you and you're constantly complaining about thep understand yeah you're constantly complaining about the symptoms with your with your girlfriends and with your significant other or complaining to your kids but what you're also saying is not only can you get relief from the symptoms and feel like yourself again and uh really optimize your health but that when you do so it increases the quality of your life and it increases your lifespan and it inre increases Your vitality over that lifespan and that's why this is so important you know one of the greatest things about social media is that this is the first time in history that women in our age group actually have found each other yeah and have started collectively saying what's going on with my weight what's going on with my joint pain what's going on with my brain fog and you don't feel alone of course I knew that the hot flash was from menopause I had no idea that the brain fog was menopausal I had no idea that uh some of the joint pain was an issue and I certainly knew that the sex drive lowering was part of what was going on but I'll tell you it was really when the belly fat and the back fat that I started to gain and I was so demoralized because I'm the kind of person that exercises six days a week I was doing everything I thought I was supposed to be doing and even more so I had stopped drinking during the week so I had lowered my drinking significantly and nothing was doing anything my pants were not fitting and it was so weird because I felt swollen all the time and like it's almost like certain part of my body didn't change but it I just had this like Tire around my center and people would be like well but you're still really thin I'm like but that's not the point right that is what where might put my toe in the water of all this menopause stuff you were me that is my exact story I literally hated the way my body looked I was self-conscious around my husband of 28 years like I didn't want him to see me naked because because I literally was like I have rolls in my back when I put my underwear on I've got my skin hanging out over it I do not know what to do and so from a pure vanity and confidence and I just want to feel like myself and this doesn't feel Fair standpoint I started to like go get whack a dooodle about it yeah I do I have to stop eating do I have to like exercise like crazy what do I need to do like what is happening and discovering that it was menopause it only kind of went okay great but then when I went to my doctor and they're like or seven years yeah like like what the hell yeah exact same thing happened to me the same feelings I was weighing myself you know you had to pee in the middle of the night cuz menopause I would weigh myself in the middle of the night in the middle of the night no wonder you weren't going back to sleep like oh my God you know and what is this constantly grabbing my belly yes so um my husband was like he was going on a trip I said when you get back you're going to have the wife you deserve I'm going to get this fat under control and he was like I love you I think you're beautiful your girls are watching this behavior and he said you're a smart girl figure this out you're a scientist and he got on the plane and I took that as you know I'm going to figure this out that I called the PHD nutritionist at the University I was employed at I was like what the hell is going on in menopause because my patients can't lose it I'm struggling I'm starving myself I'm working working at all the time they're like yeah there's something going on in menopause we think it has to do with inflammation read all these articles and hence began the Rabbit Trail for me of going down well the rabbit hole and I was like inflammation estrogen visceral fat what is this visceral fat thing no one ever taught me that in school whoa whoa whoa my diabetes risk let me check my cholesterol holy it's elevated like oh my God and then that that's why I wrote the book to put it all together so for the person listening I know what they're now thinking okay great I got to get the book but how do I find my own Dr Haver like what how do you I'm dead serious about this how do you prepare yourself to go in to your doctor and how do you find somebody who has been studying menopause right so in a perfect world you could just March into your PCP or your OBGYN even and they would be like absolutely let's go we're probably a generation away from this becoming normal so what can you do now I have a list on my website of testimonials from my followers who have found great people so that's one place the menopause Society of which I've become certified is an independent organization of people who care about menopause do research in menopause and they have a certification and training program and so you can find um at the menopause Society or menopause.org go on there and find a certified provider that's another place to start some of the new tele medicine companies coming out are built to serve the menopausal one woman I don't love it as much as an inperson visit because I do inperson visits but my God that's all they do is sit there listen to your symptoms believe you order a test if you need them and give you the hormone therapy you so desperately need I will link to absolutely everything that you've recommended including how to find you find the book uh and reach out to you in all the resources for this show awesome do you have any final words of wisdom to the person listening you know you're not crazy it's okay find a community talk about this share this with everyone we need to normalize this before we can optimize it and that don't let your daughters suffer tell them about your own experience because they're most likely going to mimic what you've gone through menopause is inevitable it's not a bad thing it is a natural process but you don't have to suffer what I love about menopause is women find this power to put themselves first for the first time in their adult lives their give a factor goes away they don't care anymore they are embracing who they are and I love that about us you know I'm more successful I never could have done this in my 30s you know that what I've been able to build and I just love that about this age but I want to keep that going Dr Haver I I just want to tell you you are a gift I am so thrilled that you took the time to be here I do think you are changing and saving people's lives I hope as you've listened to her that you've not only learned a lot about your own body but that you feel more empowered and that you have a few very simple things that you can start doing immediately and I hope one of the things that you do is that you take a moment to share this with every woman that you know and I'm not just talking the women that are Perry or postmenopausal I'm talking every woman in your life because the information today was about the design of the female body and about how estrogen and estrogen Decline and deficiency impacts her profoundly and so this really could change somebody that you care about it could change your life um so thank you thank you thank you for taking the time to be with us and I want to thank you for taking the time for yourself and taking the time to listen to something that could help you improve your life and I want to make sure to tell you in case nobody else does that I love you I believe in you and learning more about your body and your brain and your hormones and how to optimize your overall health is one of the most important things that you can do to improve your life so I know you feel empowered to do that after the conversation today and I'll talk to you in a few days oh my God Dr Mary [Applause] CL w [Applause] look forward that to every woman and young woman that I know you are incredible thank you thank you for giving me a platform oh my gosh thank you for everything you [Applause] do and to you um thank you so much for being here with me on YouTube for Real uh aren't you so empowered don't you want to send this to absolutely every single girl and woman that you know please please please share this widely this is life changing information and one more thing please hit subscribe because it allows me to continue to bring you worldclass experts at zero cost every single day new videos here on YouTube and I know what you're thinking you're thinking okay I I I want to know more I want to know more so I'm going to introduce you to the amazing Dr Amy Shaw she is going to teach you how to optimize your health and your hormones and to sleep better and you're going to love love love Dr Shaw and this 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Channel: Mel Robbins

Views: 765,685

Keywords: Mel Robbins, Mel Robbins Motivation, Mel Robbins Advice, inspiration, menopause, menopause workout, dr. mary claire haver, mary claire haver md, mary claire haver, dr. mary claire haver md, menopause doctor, #1 menopause doctor

Id: ReFZ__ZeSEQ

Length: 74min 32sec (4472 seconds)

Published: Thu Mar 21 2024