Dr. Mary Claire Haver

So and realizing, hey, if I want to do this care, I need to really step up and get some extra training.

So forever perimenopause was only defined by cycle irregularity and vasomotor symptoms like hot flashes.

So that was it.

If you didn't have those, you couldn't be in perimenopause.

And we know that's not true.

But a lot of doctors, that's the only thing that they learned was if her periods aren't irregular and she's not having hot flashes regularly,

She's just crazy.

The kind of evolution of symptoms, it usually starts in the brain.

This kind of, I can't put my finger on it.

Something's not right.

I'm more irritable.

I'm having rage.

I'm sad for no reason.

I'm not sleeping as well as I used to.

And then we see some of the systemic issues like dry skin, dry eyes, dry mouth, dry vagina, vaginal pain, loss of lubrication, body composition changes, weight gain around the midsection.

We see palpitations, ringing in the ear, itching in the ear, tendinitis.

Yes.

So we see gastrointestinal changes, the microbiome completely changes, how we recirculate estrogen and the gut changes, our gut microbiome slows.

starts becoming like a man's microbiome.

Our insulin resistance increases.