Dr. Mary Claire Haver: How to Navigate Menopause & Perimenopause for Maximum Health & Vitality

Please note that this transcript is not in its final form and will be edited.

请注意，本成绩单并非最终版本，将进行编辑。

Andrew Huberman:

安德鲁·休伯曼：

Welcome to the Huberman Lab podcast where we discuss science and science-based tools for everyday life.

欢迎来到休伯曼实验室播客，我们在这里讨论科学和基于科学的日常生活工具。

I'm Andrew Huberman and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine.

我是安德鲁·胡伯曼，斯坦福大学医学院神经生物学和眼科教授。

My guest today is Dr. Mary Claire Haver.

今天我的客人是玛丽·克莱尔·哈弗博士。

Dr. Mary Claire Haver is a board certified O-B-G-Y-N and an expert in perimenopause, menopause, and all aspects of female specific health.

Mary Claire Haver 博士是经过委员会认证的 O-B-G-Y-N，也是围绝经期、更年期和女性特定健康各个方面的专家。

During today's episode, Dr. Haver explains exactly what perimenopause and menopause represent in terms of their underlying psychology and biology and the specific actions that all women can and should take in order to navigate these stages in optimal health.

在今天的节目中，哈弗博士准确解释了围绝经期和更年期在其基本心理学和生物学方面所代表的含义，以及所有女性可以并且应该采取的具体行动，以便以最佳健康状态度过这些阶段。

She also describes the things that all women should know and do long before perimenopause arrives in order to best navigate perimenopause and menopause once they arrive.

她还描述了所有女性在围绝经期到来之前应该了解和做的事情，以便在围绝经期和更年期到来后最好地度过。

We discuss specific nutritional practices, supplementation practices, as well as conversations that you should have with your mother and with your physician, in particular your OB GYN, not just as perimenopause and menopause approach, but at every developmental stage.

我们讨论具体的营养实践、补充实践，以及您应该与您的母亲和医生（特别是您的妇产科医生）进行的对话，不仅是围绝经期和更年期的方法，而且是在每个发育阶段。

A fair amount of our discussion centers around hormone replacement therapy, not just for estrogen but for testosterone in women as well, and the many misconceptions and controversies that exist around hormone replacement therapy for menopause.

我们的大部分讨论都围绕激素替代疗法，不仅针对雌激素，还针对女性睾酮，以及围绕更年期激素替代疗法存在的许多误解和争议。

Dr. Haver explains how the specific timing in which hormone therapy is initiated plays a key role in whether or not the hormone therapy is beneficial for women or not.

哈弗博士解释了激素治疗开始的具体时机如何在激素治疗对女性是否有益方面发挥关键作用。

And of course, today's discussion gets into ways to offset some of the more common difficulties associated with menopause, including sleep issues, hot flashes, inflammation, and more.

当然，今天的讨论涉及如何抵消与更年期相关的一些更常见的困难，包括睡眠问题、潮热、炎症等。

By the end of today's episode, you'll have a clear picture from Dr. Marie Claire Haver about what perimenopause and menopause actually represent the best way to approach perimenopause and menopause and the various considerations around hormone therapy and lifestyle choices that can allow any woman to approach the years of perimenopause and menopause and beyond with the utmost vitality and wellness.

在今天的节目结束时，您将从 Marie Claire Haver 博士那里清楚地了解到围绝经期和更年期实际上代表了接近围绝经期和更年期的最佳方式，以及围绕激素治疗和生活方式选择的各种考虑因素，这些因素可以让任何女性以最大的活力和健康来迎接围绝经期和更年期及以后的岁月。

Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford.

在开始之前，我想强调一下，这个播客与我在斯坦福大学的教学和研究角色是分开的。

It is however part of my desire and effort to bring zero cost to consumer information about science and science related tools to the general public.

然而，我的愿望和努力的一部分是向公众提供有关科学和科学相关工具的零成本消费者信息。

In keeping with that theme, I'd like to thank the sponsors of today's podcast.

为了与这个主题保持一致，我要感谢今天播客的赞助商。

Our first sponsor is AeroPress.

我们的第一个赞助商是爱乐压。

AeroPress is like a French press, but a French press that always brew the perfect cup of coffee, meaning no bitterness and excellent taste.

AeroPress 就像法压壶，但法压壶总能冲泡出一杯完美的咖啡，意味着没有苦味且味道极佳。

AeroPress achieves the perfect cup of coffee because it uses a very short contact time between the hot water and the coffee.

爱乐压 (AeroPress) 实现了一杯完美的咖啡，因为它在热水和咖啡之间的接触时间非常短。

The entire thing takes only about three minutes.

整个过程只需要大约三分钟。

I started using an AeroPress over 10 years ago.

我十多年前开始使用爱乐压。

I first learned about it from a guy named Alan Adler.

我首先是从一个名叫艾伦·阿德勒的人那里得知这一点的。

He was a former Stanford engineer and inventor.

他是前斯坦福大学工程师和发明家。

He developed the Arbi Frisbee, which I believe still holds the Guinness Book World's records for the furthest throne object.

他发明了阿比飞盘，我相信它仍然保持着吉尼斯世界纪录中最远的宝座物体。

In any event, I'm a big fan of Adler's inventions, so when I heard he developed a coffee maker the AeroPress, I tried it and I found that indeed it makes the best possible tasting cup of coffee, and I'm not alone in my love of the AeroPress coffee maker.

无论如何，我是阿德勒发明的忠实粉丝，所以当我听说他开发了爱乐压咖啡机时，我尝试了一下，发现它确实可以制作出味道最好的咖啡，而且我并不是唯一一个喜欢爱乐压咖啡机的人。

With over 55,005 star reviews, AeroPress is the best reviewed coffee press in the world.

AeroPress 拥有超过 55,005 条星级评价，是世界上评价最好的咖啡机。

AeroPress also just released a new AeroPress Tumblr that makes brewing coffee when traveling or anywhere incredibly easy.

AeroPress 还刚刚发布了一款新的 AeroPress Tumblr，可以让您在旅行或任何地方冲泡咖啡变得异常简单。

This new AeroPress go Plus is incredible.

这款新的爱乐压 go Plus 令人难以置信。

It's super compact, easy to clean, and you can use it anywhere.

它超级紧凑，易于清洁，您可以在任何地方使用它。

All you need is hot water and some coffee, and again, it's very easy to clean up.

您所需要的只是热水和一些咖啡，而且清理起来也非常容易。

Also, with Father's Day coming up, it makes for a terrific Father's Day gift.

此外，随着父亲节的临近，这也是一份很棒的父亲节礼物。

If you'd like to try AeroPress, you can go to aeropress.com/huberman, get 20% off.

如果您想尝试 AeroPress，可以访问 aeropress.com/huberman，享受 20% 的折扣。

AeroPress currently ships in the USA Canada and to over 60 other countries around the world.

目前，爱乐压 (AeroPress) 向美国、加拿大和全球其他 60 多个国家/地区发货。

Again, that's aeropress.com/huberman.

同样，这是 aeropress.com/huberman。

Today's episode is also brought to us by eight Sleep.

今天的节目也是八眠给我们带来的。

Eight Sleep Makes Smart Mattress covers with cooling, heating and sleep tracking capacity.

八睡眠使智能床垫套具有冷却、加热和睡眠跟踪功能。

Now, I've spoken many times before on this podcast about the critical need for us to get adequate amounts of quality sleep each night.

现在，我之前已经在这个播客中多次谈到我们每晚获得充足的优质睡眠的迫切需要。

One of the best ways to ensure a great night's sleep is to control the temperature of your sleeping environment, and that's because in order to fall and stay deeply asleep, your body temperature actually has to drop by about one to three degrees, and in order to wake up feeling refreshed and energized, your body temperature actually has to increase by about one to three degrees.

确保一夜好眠的最佳方法之一是控制睡眠环境的温度，这是因为为了入睡并保持深度睡眠，您的体温实际上必须下降约一到三度，而为了醒来时感觉神清气爽、精力充沛，您的体温实际上必须升高约一到三度。

Eight sleep makes it incredibly easy to control the temperature of your sleeping environment by allowing you to program the temperature of your mattress cover at the beginning, middle, and end of the night.

八次睡眠让您可以轻松地控制睡眠环境的温度，您可以在晚上的开始、中间和结束时对床垫罩的温度进行编程。

Eight.

八。

Sleep also tracks your sleep with very high precision.

Sleep 还可以非常精确地跟踪您的睡眠。

It will tell you how much slow wave sleep you're getting, how much rapid eye movement sleep you're getting, each of which is critical for different aspects of physical and emotional recovery during sleep, and that allows you to dial in the exact temperature parameters to really ensure that you get the best possible night's sleep.

它会告诉您您正在获得多少慢波睡眠，您正在获得多少快速眼动睡眠，每一项对于睡眠期间身体和情绪恢复的不同方面都至关重要，并且允许您拨入准确的温度参数，以真正确保您获得最佳的夜间睡眠。

I've been sleeping on an eight sleep mattress cover for well over three years now and it has completely transformed my sleep for the better.

我已经睡在八人床床垫罩上三年多了，它彻底改变了我的睡眠质量。

Eight Sleep recently launched their newest generation pod cover the POD four Ultra.

八睡眠最近推出了他们最新一代的 Pod 套 POD 4 Ultra。

The POD four Ultra has improved cooling and heating capacity, higher fidelity sleep tracking technology, and it also has snoring detection that remarkably will automatically lift your head a few degrees to improve your airflow and stop your snoring.

POD 4 Ultra 具有改进的冷却和加热能力、更高保真度的睡眠跟踪技术，并且还具有打鼾检测功能，可以自动将您的头部抬起几度，以改善气流并停止打鼾。

If you'd like to try an eight sleep mattress cover, you can go to eight sleep.com/huberman to save $350 off their pod.

如果您想尝试 8 sleep 床垫套，您可以访问 8 sleep.com/huberman，在他们的 pod 上可节省 350 美元。

Four Ultra eight sleep currently ships to the USA Canada, UK select countries in the EU and Australia.

4 Ultra 8 sleep 目前运往美国、加拿大、英国、欧盟和澳大利亚的部分国家。

Again, that's eight sleep.com/huberman.

同样，这是八点 sleep.com/huberman。

Today's episode is also brought to us by Better Help, better Help offers professional therapy with a licensed therapist carried out completely online.

今天的节目也是由 Better Help 为我们带来的，Better Help 提供由持照治疗师完全在线进行的专业治疗。

I've been going to therapy for over 30 years.

我接受治疗已有 30 多年了。

Initially I didn't have a choice.

最初我没有选择。

It was a condition of being allowed back in high school, but soon I realized that quality therapy can be extremely valuable and I now consider doing therapy as important as getting regular exercise including cardiovascular exercise and resistance training, which of course I also do every week.

这是允许重返高中的条件，但很快我意识到高质量的治疗非常有价值，我现在认为治疗与定期锻炼一样重要，包括心血管锻炼和阻力训练，当然我每周也会这样做。

Therapy provided it's with a therapist with whom you have excellent rapport and supported by and from whom you can gain valuable insights can be immensely valuable because it leads to healthier thought patterns and actions related to your personal and professional life.

如果治疗师与您关系融洽，并得到他的支持，并且您可以从他那里获得宝贵的见解，那么治疗就会非常有价值，因为它会带来与您的个人和职业生活相关的更健康的思维模式和行动。

In fact, I see doing quality therapy as a powerful way to direct your focus and attention toward what really matters.

事实上，我认为进行优质治疗是一种有效的方法，可以将您的注意力集中在真正重要的事情上。

If you'd like to try better help, you can go to better help.com/huberman to get 10% off your first month.

如果您想尝试更好的帮助，可以访问 better help.com/huberman，第一个月可享受 10% 的折扣。

Again, that's better help.com/huberman.

同样，最好是 help.com/huberman。

And now for my discussion with Dr. Mary Claire Haver, Dr. Mary Claire Haver, welcome.

现在我与玛丽·克莱尔·哈弗博士进行讨论，欢迎玛丽·克莱尔·哈弗博士。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Thanks for having me.

谢谢你有我。

Andrew Huberman:

安德鲁·休伯曼：

Delighted to have you here and to learn about menopause and other aspects of women's health.

很高兴您来到这里并了解更年期和女性健康的其他方面。

There's a lot happening in this area right now, and you are at the center of what I understand is a new direction for the understanding and treatment of menopause.

现在这个领域发生了很多事情，而你正是我所理解的理解和治疗更年期新方向的中心。

That's what we hope and related themes like perimenopause and the many important aspects of female health that stem from it like cardiovascular disease, osteoporosis and so on.

这就是我们的希望以及相关的主题，例如围绝经期以及由此产生的女性健康的许多重要方面，例如心血管疾病、骨质疏松症等。

So we will get into all of that today.

所以我们今天将讨论所有这些。

But just to kick things off, how do we define menopause?

但首先，我们如何定义更年期？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

The medical definition of menopause, which I have a huge problem with, is one year after the final menstrual period.

我对更年期的医学定义有很大的疑问，它是末次月经后一年。

And the reason why I have a problem with it is not everyone has a menstrual period.

我之所以有这个问题，是因为并不是每个人都有月经期。

What if you've had a hysterectomy?

如果您接受了子宫切除术怎么办？

What if you have an IUD?

如果您有宫内节育器怎么办？

What if you've had an ablation or something that's suppressing your periods?

如果您接受了消融术或其他抑制月经的措施怎么办？

PCOS?

多囊卵巢综合症？

So for a lot of women and even clinicians, they are struggling to find that diagnosis because it doesn't fit everything.

因此，对于许多女性甚至临床医生来说，他们正在努力寻找这种诊断，因为它并不适合所有情况。

What it represents is something much bigger.

它所代表的东西要大得多。

Menopause is also one day of your life.

更年期也是您生命中的一天。

It is that one day, exactly one year after your last period, but it represents the end of your ovarian function.

就在你最后一次月经一年后的某一天，但它代表了你卵巢功能的终结。

Some of us call it ovarian failure, ovarian senescence, but basically what separates males and females is many things separate us, but in my world, we are born with all of our eggs.

我们中的一些人称之为卵巢衰竭、卵巢衰老，但基本上，男性和女性的区别在于我们有很多不同的东西，但在我的世界里，我们生来就拥有所有的卵子。

We have one to 2 million at birth.

我们出生时有一到两百万。

By the time we're 30, most of us are down to about 10%, maybe 120,000.

到了 30 岁的时候，我们大多数人的比例都下降到了 10% 左右，也许是 120,000。

By the time we're 40, we're down to 3% of our egg supply and the quality is declining as well.

当我们 40 岁的时候，我们的鸡蛋供应量减少到 3%，而且质量也在下降。

So menopause is when you have no more eggs left and therefore no more sex hormone or very little sex hormone production from the ovaries.

因此，更年期是指您没有更多的卵子，因此卵巢不再产生性激素或产生很少的性激素。

So estradiol levels will decline less than 1% of your reproductive years.

因此，在您的育龄期内，雌二醇水平会下降不到 1%。

Your progesterone levels will decline as well.

您的黄体酮水平也会下降。

Testosterone declines for sure, but we have other ways to produce it.

睾酮水平肯定会下降，但我们还有其他方法来产生它。

So it's somewhere 50% or less than your healthiest years.

所以它比您最健康的年份低 50% 或更少。

Andrew Huberman:

安德鲁·休伯曼：

So is it fair to say that we need a redefinition of what menopause is?

那么，我们需要重新定义什么是更年期，这样说公平吗？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

I think so.

我想是的。

I think defining it as the presence or absence of a period is a mistake.

我认为将其定义为一个时期的存在或不存在是一个错误。

Andrew Huberman:

安德鲁·休伯曼：

Is there any consensus about the typical age of onset for menopause and is it changing?

关于更年期的典型发病年龄是否存在共识并且是否正在发生变化？

I hear a lot about how the onset of puberty is shifting earlier in females and given that puberty at least by some definitions relates to the onset of menses, one could imagine that menopause would be shifting earlier as well.

我听到很多关于女性青春期开始如何提前的说法，并且考虑到青春期至少在某些定义上与月经的开始有关，人们可以想象更年期也会提前。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

So the things that determine when we have puberty or not are different than the things that determine when we run out of eggs.

因此，决定我们何时进入青春期的因素与决定我们何时耗尽卵子的因素是不同的。

Right now in the US it's the average age of that one year after year cycle.

目前在美国，这是年复一年周期的平均年龄。

So menopause that one day is about 51 to 52 years old.

那么更年期那一天大约是51岁到52岁。

However, normal is still 45 to 55, and there's a big variation that curves pretty wide.

然而，正常值仍然是 45 到 55，并且存在很大的变化，曲线相当宽。

Perimenopause begins seven to 10 years before that last menstrual period.

围绝经期开始于末次月经前 7 至 10 年。

Andrew Huberman:

安德鲁·休伯曼：

Wow, okay.

哇，好吧。

And I say, wow, because it's the first time I've ever heard a specific number tacked to this word perimenopause.

我说，哇，因为这是我第一次听到围绝经期这个词加上一个具体的数字。

Maybe we could talk a little bit about perimenopause since it sounds like it represents a transition phase into official menopause.

也许我们可以谈谈围绝经期，因为听起来它代表了正式更年期的过渡阶段。

However one chooses to define that.

然而，人们选择定义这一点。

What are some of the, I don't know if I should call them symptoms or I should just

其中有哪些，我不知道我是否应该称它们为症状，或者我应该只是

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Well, let me walk you through the endocrinology and then we can go through symptoms so you understand.

好吧，让我带您了解一下内分泌学，然后我们可以了解一下症状，以便您理解。

So in a normal healthy menstrual cycle, before menopause ever becomes an issue though, female hormone cycle is a very EK glike reproducible, monthly rise and fall of estrogen, progesterone, and then the brain hormones, lh, FS, H, and then GnRH.

因此，在正常健康的月经周期中，在更年期成为问题之前，女性激素周期是一个非常类似 EK 的可重复性的周期，雌激素、黄体酮每月上升和下降，然后是脑激素、lh、FS、H，然后是 GnRH。

So the way it works is our brain and the hypothalamus is sensing for, has a little sensor in the blood looking for estradiol levels and when they get low it sends GnRH down to the pituitary saying, Hey, tell the ovaries to start trying to ovulate so we can get more estrogen on board.

所以它的工作方式是我们的大脑和下丘脑进行感知，血液中有一个小传感器寻找雌二醇水平，当雌二醇水平降低时，它会将 GnRH 发送到垂体，说，嘿，告诉卵巢开始尝试排卵，这样我们就可以吸收更多的雌激素。

The process of ovulation is what drives up our estrogen levels.

排卵过程会提高我们的雌激素水平。

Okay, so pituitary sends out the pulses of LH and FSH, which then lead to ovulation.

好的，垂体发出 LH 和 FSH 脉冲，然后导致排卵。

When we reach in perimenopause, the beginning of perimenopause, that critical level of egg supply, those signals don't work as well.

当我们到达围绝经期时，即围绝经期的开始，卵子供应的临界水平时，这些信号就不再起作用。

We start becoming resistant to the LH and FSH AL surges, so the brain's like, Hey, I told you we need more estradiol, and the pituitary is like, I sent the signal and the brain's like send more, so we get much higher pulses of FSH and then finally the ovary kind of is able to get that egg out, but sometimes it's delayed.

我们开始对 LH 和 FSH AL 激增产生抵抗力，所以大脑就像，嘿，我告诉过你我们需要更多的雌二醇，垂体就像，我发送了信号，大脑就像发送了更多信号，所以我们得到了更高的 FSH 脉冲，然后最终卵巢能够将卵子排出体外，但有时会延迟。

So we have the timing of that monthly predictable cycle goes awry.

所以我们知道每月可预测周期出现问题的时间。

Sometimes the periods are closer together, sometimes they're further apart, but also the estrogen and progesterone levels start changing dramatically.

有时经期间隔较近，有时间隔较远，但雌激素和黄体酮水平也开始发生巨大变化。

We see much higher surges of estradiol than we ever had in our pre productive years and then much lower levels underneath.

我们看到雌二醇的激增比我们在生产前几年的任何时候都高得多，然后水平却低得多。

So we end up with this very volatile curve and not predictable at all.

所以我们最终得到了这条非常不稳定的曲线，而且根本不可预测。

We call it in our world the zone of chaos.

在我们的世界中，我们称其为混乱区。

So it is literal hormonal chaos.

所以这实际上是荷尔蒙混乱。

What used to look like this every month is now just insane and very, very, very unpredictable.

以前每个月都是这样，现在却变得疯狂而且非常非常难以预测。

That is why we don't have a good blood test in perimenopause to make the diagnosis.

这就是为什么我们在围绝经期没有进行良好的血液检查来做出诊断。

Those of us in the Meno verse use symptoms usually to make the diagnosis and we rule out other conditions that might overlap.

我们这些美诺诗中的人通常使用症状来做出诊断，并排除其他可能重叠的情况。

So perimenopause basically critical threshold, it's a downward trend overall of estradiol, but it is a very chaotic race till you flatline and bottom out.

因此，围绝经期基本上是临界阈值，雌二醇总体呈下降趋势，但这是一场非常混乱的比赛，直到您趋于平缓并触底。

Andrew Huberman:

安德鲁·休伯曼：

I see.

我明白了。

So for those listening, your description of the amplitude of the estrogen surge, it gets much greater in this perimenopause phase.

因此，对于那些听您描述的雌激素激增幅度的人来说，在围绝经期阶段它会变得更大。

You also mentioned that follicle stimulating hormone, which comes from the pituitary, has to be or somehow is upregulated in this phase because I don't know, is it that the receptors for FSH are somehow not responsive at the level of the ovary?

您还提到来自垂体的促卵泡激素在这个阶段必须或以某种方式上调，因为我不知道，FSH 受体是否在卵巢水平上没有反应？

Do we know what's happening to the ovary?

我们知道卵巢发生了什么吗？

Is it obviously the signals getting there, it's not effective, so then the brain is kicking out more FSH is it that the ovary is

很明显，信号到达那里，它没有效果，所以大脑会排出更多的 FSH，是不是卵巢在

Mary Claire Haver:

玛丽·克莱尔·哈弗：

So the A quality is poor and then around each germ cell is thecal luan cells, which is actually where the whole pathway going from actually testosterone's converted to estradiol.

因此，A 质量很差，然后每个生殖细胞周围都是鞘膜卢安细胞，这实际上是从睾酮转化为雌二醇的整个途径的地方。

So that whole pathway, it still will respond, but the cells are just old, is the way that it's been explained to me and from what I've read, I think we need a lot more research in this area because that is how we're going to help women.

所以整个途径，它仍然会做出反应，但细胞只是老了，这是向我解释的方式，从我读到的内容来看，我认为我们需要在这个领域进行更多的研究，因为这就是我们帮助女性的方式。

I think longer term is understanding that process better, but all I learned in school 25 years ago was it's the transition to menopause the end, the whole endocrinological process I didn't learn until about two years ago.

我认为从长远来看，更好地理解这个过程，但 25 年前我在学校学到的只是向更年期结束的过渡，直到大约两年前我才了解整个内分泌过程。

Andrew Huberman:

安德鲁·休伯曼：

And my guess is just based on my understanding of the only recent trend toward emphasizing studies of both female and male, even just mice in mouse models, which is where generally this stuff originates and then it shifts into humans once certain targets are identified.

我的猜测只是基于我对最近唯一的趋势的理解，即强调对雌性和雄性的研究，甚至只是小鼠模型中的小鼠，这通常是这种东西的起源，然后一旦确定了某些目标，它就会转移到人类身上。

Only recently has the NIH insisted that there be female mice in the studies of mice.

直到最近，美国国立卫生研究院才坚持在小鼠研究中必须使用雌性小鼠。

I mean it's been a few years now, but that's sex as a biological variable is actually a requirement in most grant applications unless of course there's a specific reason to study only one or the other sex of mice.

我的意思是已经过去了几年了，但性别作为一种生物变量实际上是大多数拨款申请的要求，当然除非有特定的原因只研究小鼠的一种或另一种性别。

So you can imagine that the dearth of research in this area is due to a long desert of absence of studies into what is perimenopause, right?

所以你可以想象，这一领域研究的缺乏是由于长期缺乏对围绝经期的研究，对吗？

So for women who are in the age range of perimenopausal or who are thinking about this, are there things that they can do in order to either upregulate the sensitivity of the ovary to FSH or to somehow prolong this period of perimenopause?

那么，对于处于围绝经期年龄范围或正在考虑这个问题的女性来说，是否可以采取一些措施来上调卵巢对 FSH 的敏感性或以某种方式延长围绝经期？

And I should also say what are some reasons why they would want to do that?

我还应该说他们想要这样做的原因是什么？

Obviously this is part of the arc of maturation of the female reproductive axis, but of course that alone is not a reason to not try and I guess we say optimize it for one's wellbeing.

显然，这是女性生殖轴成熟弧线的一部分，但当然，仅此一点并不是不尝试的理由，我想我们说为了一个人的福祉而优化它。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

We don't know the best way I can highlight why we don't know or where the dollars are going for research, we go to PubMed and you type in the word pregnancy, 1.1 million articles come up, type in the word menopause, it's down to 97,000.

我们不知道最好的方法，我可以强调为什么我们不知道，也不知道研究的资金花在哪里，我们去 PubMed，你输入“怀孕”这个词，就会出现 110 万篇文章，输入“更年期”这个词，就会下降到 97,000 篇。

Really, you type in the word perimenopause and I checked this two weeks ago and it was like 6,400 and something.

真的，你输入“围绝经期”这个词，我两周前查了一下，大约是 6,400 之类的。

Wow.

哇。

Andrew Huberman:

安德鲁·休伯曼：

Yeah.

是的。

That is surprising.

这是令人惊讶的。

Or maybe it shouldn't be surprising given what we were just talking about in terms of,

或者考虑到我们刚才谈论的内容，这应该不足为奇，

Mary Claire Haver:

玛丽·克莱尔·哈弗：

So as far as why those cells are becoming resistant and what's happening at the level of the receptor, I think we need a lot more research in this area.

至于为什么这些细胞会产生耐药性以及受体水平上发生了什么，我认为我们需要在这个领域进行更多的研究。

I think it's starting to happen because women are realizing there's a demand now because the older you are when you go through menopause, the healthier you are for cardiometabolic disease.

我认为这种情况已经开始发生，因为女性意识到现在存在需求，因为更年期年龄越大，心脏代谢疾病就越健康。

It's the loss of estrogen that accelerates our path to those diseases.

雌激素的丧失加速了我们罹患这些疾病的进程。

Andrew Huberman:

安德鲁·休伯曼：

So are there clinical signs of perimenopause that either directly or indirectly relate to these bigger surges in FSH and these larger amplitude estrogen surges?

那么，围绝经期的临床症状是否与 FSH 的大幅波动和雌激素的大幅波动直接或间接相关？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

The two best documented and studied are mental health changes.

记录和研究最充分的两个是心理健康变化。

The brain does not like the chaos of and the neurotransmitters are very, very sensitive to estrogen and progesterone and even testosterone.

大脑不喜欢混乱，神经递质对雌激素、孕激素甚至睾酮非常非常敏感。

And so we see aberrations in serotonin and norepinephrine and in dopamine as the levels start becoming chaotic.

因此，随着水平开始变得混乱，我们看到血清素、去甲肾上腺素和多巴胺出现异常。

So we have at least a 40% increase of mental health disorders and SSRI use doubles across the menopause transition across perimenopause.

因此，精神健康障碍至少增加了 40%，并且 SSRI 的使用在更年期过渡期间翻了一番。

Now the data is showing that women who are given hormone therapy in their perimenopause have a lower incidence of new onset depression, and now the neuroscientists are saying, Hey, for these women who are developing depression in perimenopause, giving them estrogen is better than an SSRI, they're going to have a better outcome.

现在数据显示，在围绝经期接受激素治疗的女性新发抑郁症的发生率较低，现在神经科学家说，嘿，对于这些围绝经期出现抑郁症的女性来说，给予她们雌激素比 SSRI 更好，她们会得到更好的结果。

Andrew Huberman:

安德鲁·休伯曼：

I think most people don't realize how rich the brain and rest of the nervous system are with hormone receptors in particular estrogen receptors and as you mentioned, testosterone receptors as well, androgen receptors and the often direct relationship between estrogen and the neuromodulators such as serotonin, dopamine, epinephrine, acetylcholine,

我认为大多数人没有意识到大脑和神经系统的其余部分有多么丰富的激素受体，特别是雌激素受体，正如你提到的，还有睾酮受体、雄激素受体以及雌激素和神经调节剂（如血清素、多巴胺、肾上腺素、乙酰胆碱）之间通常直接的关系，

Mary Claire Haver:

玛丽·克莱尔·哈弗：

And GABA for progesterone.

GABA 代表黄体酮。

Andrew Huberman:

安德鲁·休伯曼：

Yeah, it's interesting.

是的，这很有趣。

During neural development, which is where I started off, which was neural embryonic development, the hormones exert these widespread roles in defining even which neurons will express certain neurotransmitters.

在神经发育过程中，也就是我开始的神经胚胎发育过程中，激素在定义哪些神经元将表达某些神经递质方面发挥着广泛的作用。

And then somehow the field of neurosciences only recently gotten on board.

然后不知怎的，神经科学领域最近才加入进来。

The idea that this intimate relationship between hormones and neurotransmitters is something to consider in essentially every aspect of brain health, not just cognition, but maintenance of neurons and offsetting neurodegeneration and so on.

激素和神经递质之间的这种密切关系实际上是在大脑健康的各个方面都需要考虑的想法，不仅仅是认知，还包括神经元的维护和抵消神经退行性变等。

I mentioned that only so that people, I think typically think of hormones as something, sure, there's a signal from the brain, but that hormones are mostly of the body when in fact hormones play an absolutely crucial role within the brain.

我提到这一点只是为了让人们通常认为激素是某种东西，当然，有来自大脑的信号，但激素主要是身体的，而事实上激素在大脑中起着绝对重要的作用。

So you mentioned that during perimenopause there are symptoms that are, I guess are mainly reflected as shifts in mental health.

所以你提到，在围绝经期期间，有一些症状，我想主要反映为心理健康的变化。

So is this women suddenly feeling kind of less optimistic?

那么，这些女性是不是突然感觉不那么乐观了？

What's the sort of constellation psychological shifts that can occur?

可能发生什么样的星座心理转变？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

So we see increasing anxiety.

所以我们看到焦虑不断增加。

We see definitely loss of executive functioning, so new onset of a DD type symptoms.

我们肯定会看到执行功能丧失，因此出现新的 DD 型症状。

We see of course the cognitive, what we call brain fog and lay terminology, which is cognitive, so they lose their words.

我们当然看到了认知，我们称之为脑雾和外行术语，这是认知，所以他们失去了话语。

They're not able to do the calculations at work, like they're executive functioning ability in their jobs is huge.

他们无法在工作中进行计算，就像他们在工作中的执行能力很强一样。

One in five women will quit their jobs because of menopause symptoms.

五分之一的女性会因为更年期症状而辞职。

Andrew Huberman:

安德鲁·休伯曼：

That's an outrageous

这是一个令人愤慨的

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Number and the economic impact is huge.

数量和经济影响是巨大的。

And so now companies are starting to get on board and this is the time of our lives when the kids are grown for a lot of us and we're ready to lean into our positions and really get into leadership.

所以现在公司开始加入进来，这是我们生命中的一个时刻，我们很多人的孩子都长大了，我们已经准备好进入我们的职位并真正进入领导地位。

We all have this experience and now all of a sudden these and their confidence is just wrecked and then the depression and they're not sleeping and it's this horrible feedback cycle that they end up in that we end up in.

我们都有过这样的经历，现在突然之间，这些人和他们的信心被摧毁了，然后是抑郁症，他们不睡觉，这是一个可怕的反馈循环，他们最终陷入了我们最终陷入的困境。

Andrew Huberman:

安德鲁·休伯曼：

Yeah, I wasn't aware that one in five is striking that came

是的，我不知道五分之一的人是惊人的

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Out of the uk, but they're starting to crunch the numbers here in the US and it's looking very similar.

在英国之外，但他们开始在美国计算数据，情况看起来非常相似。

Andrew Huberman:

安德鲁·休伯曼：

I know we're going to get into actionable tools later as it relates to menopause, but as long as we're discussing this phase of perimenopause, what are some of the basic things that women could a pay attention to?

我知道我们稍后会讨论与更年期相关的可行工具，但只要我们讨论围绝经期的这个阶段，女性可以注意哪些基本事项？

We don't want to make people hypervigilant to the point of anxiety, but certainly given the frequency and given the implications, it's important for them to pay attention to this phase.

我们不想让人们过度警惕到焦虑的地步，但考虑到发生的频率和影响，他们关注这一阶段是很重要的。

And then some of the things that they can do to either behaviorally or perhaps through other tools offset some of these changes.

然后他们可以在行为上或通过其他工具做一些事情来抵消其中的一些变化。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Sure.

当然。

Dysfunctional uterine bleeding, which is abnormal periods, and again, nothing's off the table.

功能失调性子宫出血，即月经异常，同样，没有什么是不可能的。

It could be heavy periods, menorrhagia too frequent, too few skipping.

可能是月经过多、月经过多、漏经次数太少。

It's really, really chaotic, but a lot of women are suffering horribly from really debilitating periods, either through the volume of blood loss or they're having cramps and really, and so 90% of us will have that as a symptom.

这真的非常非常混乱，但是很多女性都在经历非常虚弱的时期，要么是失血量大，要么是抽筋，所以我们 90% 的人都会有这种症状。

Fatigue is a huge one.

疲劳是一个巨大的问题。

A lot of them, the symptoms are kind of vague and can be attributed to a lot of other things.

其中很多症状都比较模糊，可以归因于很多其他原因。

In my, what we call the menopausal chat group, we have a lot of theories about a lot of conditions like fibromyalgia and the irritable bladder syndromes and that probably just perimenopause and menopause and doctors didn't know how to make that diagnosis.

在我的更年期聊天小组中，我们有很多关于纤维肌痛和膀胱过敏综合症等病症的理论，而且可能只是围绝经期和更年期，而医生不知道如何做出诊断。

And so musculoskeletal system takes a huge hit to the transition.

因此，肌肉骨骼系统在转变过程中受到了巨大的打击。

So all of a sudden you have no injury and you're having hip pain, joint pain, back pain with, you go to the doctor and you get an X-ray, you do whatever workup and they can't find anything wrong.

所以突然之间，你没有受伤，但你有髋部疼痛、关节疼痛、背部疼痛，你去看医生，做了 X 光检查，你做了任何检查，他们都找不到任何问题。

Palpitations are huge.

心悸是巨大的。

It is a vasomotor symptom.

这是一种血管舒缩症状。

So along with hot flashes, palpitations, so a woman will walk into the emergency room sweating profusely, horrible palpitations, she's anxiety, and they'll tell us she's having a panic attack.

因此，伴随着潮热、心悸，一个女人会大汗淋漓地走进急诊室，可怕的心悸，她很焦虑，他们会告诉我们她惊恐发作了。

They'll work her up, everything's negative and just say, well, it's panic attack, go home.

他们会让她兴奋起来，一切都是负面的，然后就说，好吧，这是恐慌症发作，回家吧。

And no one knew to connect the dots and figure out that this woman was in her menopause transition and this is how her body was expressing it.

没有人知道将这些点联系起来并弄清楚这位女性正处于更年期过渡期，而这就是她的身体表达的方式。

It's complicated because we have sex hormone receptors as you do, and every organ system of our body.

这很复杂，因为我们和你们一样有性激素受体，以及我们身体的每个器官系统。

And when these levels start going chaotic, it can present in so many different ways.

当这些层次开始变得混乱时，它会以多种不同的方式呈现。

And so when the patients come to me, I'm doing blood work, not a lot of hormone levels because they're not super helpful, but I am doing thyroid workups and autoimmune workups and looking for nutritional deficiencies and anemia and different things because I don't want to miss those things and just pin everything on perimenopause.

因此，当患者来找我时，我会进行血液检查，而不是检查大量激素水平，因为它们不是很有帮助，但我会进行甲状腺检查和自身免疫检查，并寻找营养缺乏和贫血等其他情况，因为我不想错过这些事情，而只是将所有事情都归咎于围绝经期。

Andrew Huberman:

安德鲁·休伯曼：

Are there lifestyle factors that can offset some of this?

生活方式因素是否可以抵消部分影响？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

It's not a perfect correlation, but the healthier you are, so anti-inflammatory diet, Mediterranean es Allison, diet esque nutrition pattern, regular exercise, good sleep habits, all the pillars of health, the healthier you are when you hit perimenopause, the better the course is going to be for you.

这不是一个完美的相关性，但你越健康，所以抗炎饮食、地中海艾利森饮食、饮食式营养模式、定期锻炼、良好的睡眠习惯，所有健康的支柱，当你进入更年期时，你越健康，课程就越适合你。

They're looking at extending the life of the ovary.

他们正在考虑延长卵巢的寿命。

With pharmacology, we know what can shut it down faster.

通过药理学，我们知道什么可以更快地关闭它。

So we have kind of a genetic predetermined age of when you're going to lose all your eggs, but we can speed that up.

因此，我们有一个基因预先确定的年龄，即您将失去所有卵子的年龄，但我们可以加快这一速度。

So if you smoke, you're going to go through menopause sooner than your twin would have if she didn't smoke.

因此，如果你吸烟，你会比你的双胞胎不吸烟更早进入更年期。

Okay.

好的。

If you don't have children and you ovulate regularly, then the more you ovulate, the faster you run through your egg supply.

如果您没有孩子并且排卵正常，那么排卵越多，卵子供应就越快。

Okay, interesting.

好吧，有趣。

Andrew Huberman:

安德鲁·休伯曼：

I wasn't aware of those data.

我不知道这些数据。

I don't know that most people are

我不知道大多数人都是

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Aware of those data.

了解这些数据。

No. If you have a hysterectomy and you leave your ovaries behind, I didn't ever counsel my patients about this.

不。如果您进行了子宫切除术并且保留了卵巢，我从来没有就此向我的患者提供咨询。

You lose four years off the life of your ovaries.

你的卵巢寿命会缩短四年。

If you have a tubal ligation, you usually lose a year and a half.

如果您进行输卵管结扎术，通常会损失一年半的时间。

Huge genetic disparities.

巨大的遗传差异。

So African-Americans tend to go through a year and a half sooner, and then there's Caucasians in the middle, and then Asian family tend to go through later and they're not sure why a year or two years.

因此，非洲裔美国人往往会提前一年半，然后是中间的白人，然后亚洲家庭往往会晚一些，他们不知道为什么要一年或两年。

So there are, if you have chemotherapy, if you have surgery, if you have any inflammatory process in the abdomen, irritable bowel or endometriosis, you are going to lose some of the life of the ovary.

所以，如果你接受化疗，如果你接受手术，如果你腹部有任何炎症过程、肠易激或子宫内膜异位症，你就会失去一些卵巢的生命。

Andrew Huberman:

安德鲁·休伯曼：

You mentioned smoking.

你提到吸烟。

Are there any data on vaping?

有没有关于vaping的数据？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Not yet.

还没有。

I haven't seen any.

我还没见过。

There might be out there.

那里可能有。

I just haven't seen it yet.

我只是还没有看到它。

No.

不。

Andrew Huberman:

安德鲁·休伯曼：

I'm guessing if they're out there, they're not prominent or you would've seen them.

我猜如果他们在那里，他们并不突出，否则你会看到他们。

I'm curious about vaping because a lot of people are vaping instead of smoking, and hopefully people are neither vaping nor smoking because it seems that we had an expert on vaping on the podcast recently from Stanford, and it seems that there's nothing great about it, and there may be some things really bad about it, but I was just curious given that a number of young women and men for that matter are vaping nowadays.

我对电子烟很好奇，因为很多人都在电子烟而不是吸烟，希望人们既不电子烟也不吸烟，因为我们最近在斯坦福大学的播客上似乎有一位关于电子烟的专家，这似乎没有什么了不起的，而且可能有一些非常糟糕的事情，但我只是很好奇，因为现在有很多年轻男女都在电子烟。

I

我

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Think

思考

Andrew Huberman:

安德鲁·休伯曼：

Probably need where our smoking rates have gone way, way down

可能需要我们的吸烟率大幅下降

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Another 10 years before we'd be able to see when those women are going through menopause because vaping, I think vaping is younger.

再过十年，我们就能看到这些女性因为吸电子烟而进入更年期，我认为吸电子烟更年轻。

The younger generation, like my kids, their friends, people

年轻一代，比如我的孩子、他们的朋友、人们

Andrew Huberman:

安德鲁·休伯曼：

In their twenties and thirties,

在二三十岁的时候，

Mary Claire Haver:

玛丽·克莱尔·哈弗：

10 to eight.

十到八。

So we're 20 years out from seeing how it's going to affect them.

因此，我们还需要 20 年才能看到这将如何影响他们。

Andrew Huberman:

安德鲁·休伯曼：

Is there any evidence that alcohol can impact

有没有证据表明酒精会影响

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Perimenopause?

围绝经期？

I haven't seen any, but I can't imagine that heavy use of alcohol would prolong the life of the ovary in any way.

我没有见过，但我无法想象大量饮酒会以任何方式延长卵巢的寿命。

Andrew Huberman:

安德鲁·休伯曼：

And we know that any use of alcohol has some potential role in disrupting sleep, presumably.

我们知道，任何饮酒都可能会扰乱睡眠。

Hundred percent.

百分之百。

Presumably like everything else, if you disrupt sleep, you disrupt things, everything for the worst.

想必就像其他事情一样，如果你扰乱了睡眠，你就会扰乱一切，一切都会变得最糟糕。

Got it.

知道了。

So you mentioned rough ages for onset of menopause, 51, but anywhere from 45 to 55.

所以你提到了更年期开始的大致年龄，51 岁，但也可以是 45 岁到 55 岁之间。

And the perimenopause is defined as a period about seven years prior to that.

围绝经期被定义为在此之前大约七年的时期。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Seven to 10, yeah.

七到十，是的。

Okay.

好的。

Andrew Huberman:

安德鲁·休伯曼：

What's the earliest you've ever had a patient come in who entered menopause?

您接诊的患者最早是在什么时候进入更年期的？

What's the

什么是

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Latest you've ever seen?

你见过的最新的吗？

My personal patient 27, and she came in just a couple months ago.

我的私人病人 27 岁，她几个月前才来。

So she had a special condition we call premature ovarian failure, and she had found me on social media and wanted to come just to make sure she was doing everything right.

所以她患有一种特殊的病症，我们称之为卵巢早衰，她在社交媒体上找到了我，并想来确保她做的一切都是正确的。

And so early menopause is defined as between the ages of 40 and 45 and then premature menopause or premature ovarian insufficiency.

因此，提前绝经被定义为 40 至 45 岁之间，然后过早绝经或卵巢早衰。

It's not a complete failure for most women, but it is very, very low is anytime before the age of 40.

对于大多数女性来说，这并不是完全失败，但在 40 岁之前的任何时候，这种情况都非常非常低。

So this patient kind of got kicked around for two years, went to her doctor, no periods, horrible hot flashes.

所以这个病人被踢了两年，去看医生，没有月经，还有可怕的潮热。

Again, she was 25 and it was not on his radar, and he never tested her for menopause, and it took her 18 months to get the diagnosis.

再说一遍，她已经 25 岁了，这不在他的关注范围内，他也从未对她进行过更年期检查，她花了 18 个月才得到诊断。

And so the longer your body is away from estrogen, the higher the risk factor and been all over the news this week where we know that untreated premature ovarian insufficiency has a earlier death, so they have higher cardiovascular disease, diabetes, stroke, all because estrogen is so protective and they have to go so long without it, we can back negate most of those risks by giving her aggressive hormone therapy early.

因此，你的身体远离雌激素的时间越长，风险因素就越高，这周的新闻到处都是，我们知道未经治疗的卵巢早衰会导致较早死亡，因此他们患心血管疾病、糖尿病、中风的几率更高，所有这些都是因为雌激素具有很强的保护作用，他们必须长期没有雌激素，我们可以通过尽早给予她积极的激素治疗来消除大部分风险。

So she came in to make sure she was on the right dose because in premature ovarian failure, we don't want to give them menopausal hormone therapy doses.

所以她进来是为了确保她服用了正确的剂量，因为在卵巢早衰的情况下，我们不想给他们服用更年期激素治疗剂量。

They're too low.

他们太低了。

We want to get her more like she would have, which is three to four times the amount of estrogen as a reproductive aged woman.

我们想让她更像她应该拥有的那样，雌激素含量是育龄女性的三到四倍。

And she wanted to have a period, so she would seem like her friends.

她想要来月经，这样她看起来就像她的朋友一样。

It was an emotional thing for her, which I totally respect.

这对她来说是一件情感上的事情，我完全尊重。

And so we were doing cyclical progesterone for her so that she would have a withdrawal bleed and feel like she was normal.

所以我们为她服用周期性黄体酮，这样她就会出现撤退性出血，并感觉自己很正常。

Andrew Huberman:

安德鲁·休伯曼：

Basic question, but I'm curious, I'll ask, given that levels of estrogen change so much naturally during the course of the ovulation cycle menstrual cycle with estrogen therapy, is it a constant dose or it's modulated by week to week

基本问题，但我很好奇，我会问，鉴于雌激素水平在雌激素治疗的排卵周期月经周期过程中自然变化如此之大，是恒定剂量还是每周调节

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Or day to day?

还是日复一日？

So there are some formula, and when we look at hormonal contraception, so the biggest difference between contraceptive doses and menopause hormone therapy doses, they're both based in estrogen and progesterone.

所以有一些公式，当我们研究激素避孕时，避孕剂量和更年期激素治疗剂量之间的最大区别是，它们都基于雌激素和黄体酮。

Mostly.

大多。

The hormone therapy was developed to stop a hot flash for decades, menopause was defined by the presence or absence.

几十年来，激素疗法一直是为了阻止潮热而开发的，更年期是根据是否出现潮热来定义的。

Severe menopause was defined by hot flashes or not, nothing else.

严重更年期的定义是是否潮热，仅此而已。

And so they developed the formulations with enough estrogen to stop hot flashes.

因此，他们开发了含有足够雌激素的配方来阻止潮热。

Birth control was developed to stop ovulation.

节育措施是为了停止排卵而开发的。

You don't ovulate, you don't get pregnant, and it's, but the difference between low dose birth control pill and higher dose menopause hormone therapy is not that far away.

你不会排卵，你不会怀孕，确实如此，但低剂量避孕药和高剂量更年期激素疗法之间的区别并不遥远。

And so that a lot of people don't understand.

以至于很多人不理解。

Now, the types of estrogen we use in birth control are a little bit different.

现在，我们在节育中使用的雌激素类型有点不同。

Most birth control is ethanol estradiol, which is one of the synthetics.

大多数避孕药是乙醇雌二醇，它是合成物之一。

We have literally millions and millions of women's year data on it.

我们确实拥有数以百万计的女性年度数据。

We know it's safety profile.

我们知道它的安全性。

I think we're not counseling patients adequately about birth control as far as what it does to their testosterone and what it can do to, oh, it's fine, it's safe.

我认为我们没有向患者提供有关节育的充分咨询，就其对睾丸激素的影响以及它可以产生的影响而言，哦，没关系，它是安全的。

I took it for years.

我花了很多年。

But I think we need to do a better job as a specialty on counseling women, but I do think it's a good medication.

但我认为我们需要在女性咨询方面做得更好，但我确实认为这是一种很好的药物。

And then on menopause hormone therapy, it's much lower dose.

然后在更年期激素治疗中，剂量要低得多。

It does not suppress ovulation.

它不会抑制排卵。

So in perimenopause it's a little bit of the wild west, which one we're going to use, how high do we want to go?

因此，在围绝经期，这有点像狂野西部，我们将使用哪一个，我们想要达到多高？

Do we need to suppress her ovulation because she's got acne or horrible periods or cramps or something where I want to suppress that ovulation to help her, or can I give her menopause hormone therapy doses, which in effect, think of the hypothalamus.

我们是否需要抑制她的排卵，因为她有痤疮或可怕的月经或痉挛或我想抑制排卵以帮助她的东西，或者我可以给她更年期激素治疗剂量，这实际上是考虑下丘脑。

I'm giving her just enough estrogen to calm the brain down and tell 'em everything's okay.

我给了她足够的雌激素来让大脑平静下来并告诉他们一切都好。

We're not going to get those big peaks and drops.

我们不会遇到那些大的高峰和大的下降。

And if she still ovulates, that's okay too.

如果她仍然排卵，那也没关系。

Andrew Huberman:

安德鲁·休伯曼：

As many of you know, I've been taking AG one for more than 10 years now.

正如你们很多人所知，我服用 AG 1 已有 10 多年了。

So I'm delighted that they're sponsoring this podcast.

所以我很高兴他们赞助这个播客。

To be clear, I don't take AG one because they're a sponsor, rather.

需要明确的是，我选择 AG 并不是因为他们是赞助商。

They are a sponsor because I take AG one.

他们是赞助商，因为我拿了 AG 的赞助商。

In fact, I take AG one once and often twice every single day.

事实上，我每天服用一次 AG 一次，通常服用两次。

And I've done that since starting way back in 2012.

我从 2012 年就开始这么做了。

There is so much conflicting information out there nowadays about what proper nutrition is.

关于什么是适当的营养，现在有很多相互矛盾的信息。

But here's what there seems to be a general consensus on whether you're an omnivore, a carnivore, a vegetarian, or a vegan.

但对于你是杂食动物、肉食动物、素食主义者还是纯素食主义者，人们似乎达成了普遍共识。

I think it's generally agreed that you should get most of your food from unprocessed or minimally processed sources, which allows you to eat enough but not overeat, get plenty of vitamins and minerals, probiotics and micronutrients that we all need for physical and mental health.

我认为人们普遍认为，你的大部分食物应该来自未加工或最低限度加工的来源，这样你就可以吃得足够，但不会吃得过多，获得充足的维生素和矿物质、益生菌和微量营养素，这些都是我们身心健康所需要的。

Now, I personally am an omnivore and I strive to get most of my food from unprocessed or minimally processed sources.

现在，我个人是杂食动物，我努力从未加工或最低限度加工的来源获取大部分食物。

But the reason I still take AG one once and often twice every day is that it ensures I get all of those vitamins, minerals, probiotics, et cetera, but it also has adaptogens to help me cope with stress.

但我仍然每天服用一次 AG 丸（通常是两次）的原因是它可以确保我获得所有维生素、矿物质、益生菌等，而且它还含有适应原来帮助我应对压力。

It's basically a nutritional insurance policy meant to augment, not replace quality food.

它基本上是一项营养保险政策，旨在增强而不是取代优质食品。

So by drinking a serving of ag one in the morning, and again in the afternoon or evening, I cover all of my foundational nutritional needs.

因此，通过早上喝一份 ag，然后在下午或晚上再喝一次，我就可以满足我所有的基本营养需求。

And I like so many other people that take AG one report feeling much better in a number of important ways such as energy levels, digestion, sleep, and more.

我和很多其他人一样，服用 AG 一份报告后，他们在许多重要方面都感觉好多了，例如能量水平、消化、睡眠等。

So while many supplements out there are really directed towards obtaining one specific outcome, ag one is foundational nutrition designed to support all aspects of wellbeing related to mental health and physical health.

因此，虽然许多补充剂实际上是为了获得一种特定的结果，但一种补充剂是基础营养，旨在支持与心理健康和身体健康相关的各个方面的福祉。

If you'd like to try ag one, you can go to drink ag one.com/huberman to claim a special offer.

如果您想尝试 ag one，可以前往 Drink ag one.com/huberman 申请特别优惠。

They'll give you five free travel packs with your order plus a year supply of vitamin D three K two.

您订购后，他们将赠送您 5 个免费旅行套装，外加一年的维生素 D 3 K 2 份。

Again, that's drink ag one.com/huberman.

再说一遍，这是 Drink ag one.com/huberman。

As long as we're on the topic of birth control.

只要我们谈论节育话题。

Earlier you mentioned that the IUD, and presumably this is some forms of the IUD, not necessarily copper IUD, can disrupt or stop a,

之前您提到宫内节育器，大概是某些形式的宫内节育器，不一定是铜宫内节育器，可以扰乱或阻止，

Maybe we could talk a little bit about the different forms of birth control IUD as the pill old term, but I think most people know what we're referring to when we say that the ring and on and on.

也许我们可以稍微讨论一下不同形式的节育宫内节育器（作为避孕药的旧术语），但我想大多数人都知道当我们说环等等时我们指的是什么。

What is your stance on these different forms of birth control as it relates to their safety?

您对这些不同形式的节育措施的立场是什么，因为这关系到它们的安全？

I guess about a year and a half ago, I hosted a female physician guest on this podcast, and both sides of the birth control issue were touched on it.

我想大约一年半前，我在这个播客上接待了一位女医生嘉宾，其中涉及了节育问题的双方。

One, the relationship to potential inhibition of certain forms of cancers, but then also the potential for certain side effects, maybe even cancers.

一是与某些形式的癌症的潜在抑制有关，但也与某些副作用（甚至可能是癌症）的可能性有关。

And so it seems like it can play out both ways.

所以看起来它可以双向发挥作用。

And this is a very heated topic, in fact, so much so that I learned that if one is going to post a clip of any of this on social, it almost makes sense to have them in the same post because we actually did both of them.

事实上，这是一个非常热门的话题，以至于我了解到，如果有人要在社交媒体上发布其中任何一个片段，那么将它们放在同一篇文章中几乎是有意义的，因为我们实际上都做了这两个片段。

We did a post where it was more about the pros of birth control and then the cons of birth control as stated through the words of this very same clinician.

我们发表了一篇文章，其中更多地介绍了节育的优点，然后通过这位临床医生的话阐述了节育的缺点。

So we will be sure to.

所以我们一定会这样做。

So for anyone listening, whichever answer comes first, stay tuned for the next answer because my understanding is that it's not a black and white issue.

因此，对于任何倾听的人，无论哪个答案先出现，请继续关注下一个答案，因为我的理解是，这不是一个非黑即白的问题。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

I think the best form of birth control is a vasectomy, and so much of contraception is dumped in a female's lap in a committed relationship.

我认为最好的节育方式是输精管结扎术，而在一段忠诚的关系中，很多避孕措施都被倾倒在女性的腿上。

And I can't tell you the comments I've heard.

我无法告诉你我听到的评论。

When a patient comes to me and she wants to get X, Y, and Z simply for contraception, she's absolutely perfectly healthy.

当一位患者来找我，她只是为了避孕而想要获得 X、Y 和 Z 时，她绝对是完全健康的。

There's nothing wrong with her.

她没有什么问题。

She just doesn't want to be pregnant.

她只是不想怀孕。

And I'm like, okay, you're done.

我说，好吧，你完成了。

She's completed her family, she's out.

她已经完成了她的家庭，她出去了。

And I'm like, tell your partner to get a vasectomy or he won't do that.

我想，告诉你的伴侣进行输精管结扎术，否则他不会这样做。

So now all of the risk and the onus goes on her.

所以现在所有的风险和责任都由她承担。

And so we go through the options of surgical tubal ligation, which is basically blocking the tube.

因此，我们选择了输卵管结扎手术，这基本上是阻塞输卵管。

So when I talk to my teenagers, I'm like, here's how you not get pregnant.

所以当我和我的青少年谈话时，我想，这就是如何避免怀孕的方法。

A, you don't have sex.

答：你们没有发生性行为。

Well, if that's not an option, then we have to either block the sperm, stop the egg from coming out or stop the place where they communicate, which is the fallopian tube.

好吧，如果这不是一个选择，那么我们必须要么阻止精子，阻止卵子出来，要么阻止它们交流的地方，即输卵管。

And so when we look at the different forms of hormonal contraception, which are meant to stop ovulation, suppress ovulation, because they're telling the brain, we have enough estrogen, progesterone on board, quiet down so it doesn't send those signals to the ovary.

因此，当我们观察不同形式的激素避孕药时，它们的目的是停止排卵、抑制排卵，因为它们告诉大脑，我们有足够的雌激素、黄体酮，安静下来，这样它就不会向卵巢发送这些信号。

Right?

正确的？

And so that can come in a pill form a patch form a ring form, and they each have their own pros, cons, risk benefits.

因此，它们可以是药丸形式、贴片形式、环形形式，它们各自有自己的优点、缺点和风险收益。

Transdermal has less risk of blood clots versus oral has a higher risk of blood clot in any form of estrogen.

任何形式的雌激素，经皮给药产生血栓的风险较低，而口服给药则产生血栓的风险较高。

So we talk about that.

所以我们谈论这个。

We look at their family history or if they have M-T-H-F-R, any of the clotting genes, then we counsel directly versus the IUD.

我们会查看他们的家族史，或者他们是否有 M-T-H-F-R 或任何凝血基因，然后我们会直接建议是否使用宫内节育器。

The IUDs create an inflammatory environment in the uterus that blocks and it creates a plug in the cervix so that the sperm can't get through.

宫内节育器会在子宫内产生炎症环境，从而阻塞子宫颈，使精子无法通过。

And then if any do get through, it's a toxic environment in the uterine cavity for the sperm.

如果有任何东西通过了，那么子宫腔内的环境对于精子来说就是一个有毒的环境。

So that's really how those IUDs work.

这就是宫内节育器的工作原理。

Some IUDs are coated with progesterone or progestin, not progesterone, progestogen, and those end up deci the endometrium.

有些宫内节育器涂有黄体酮或孕激素，而不是黄体酮、孕激素，这些最终会破坏子宫内膜。

So thinning that lining from that constant progesterone to the point where you stop bleeding.

因此，使内膜从持续的黄体酮变薄到停止流血的程度。

So a lot of my patients really loved that option of being amenorrheic, no periods just for the convenience of it, but they were still ovulating in the background.

所以我的很多病人真的很喜欢闭经的选择，没有月经只是为了方便，但他们仍然在后台排卵。

So we're not suppressing their natural cycles, just their periods.

所以我们并不是抑制它们的自然周期，而是抑制它们的周期。

Andrew Huberman:

安德鲁·休伯曼：

I see.

我明白了。

And is there any evidence that the use of any form of birth control can disrupt the timing or the good question availability of, I realize availability of ag is a very clinically naive, biologically naive statement, but basically what I'm saying, can any of them accelerate the onset of perimenopause?

是否有任何证据表明使用任何形式的节育措施都会破坏时间或好问题的可用性，我意识到 ag 的可用性在临床上是一个非常幼稚的、生物学上幼稚的陈述，但基本上我要说的是，它们中的任何一个都可以加速围绝经期的开始吗？

Can they delay the onset of

他们可以推迟发病吗

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Perimenopause?

围绝经期？

They'll delay the onset a little bit.

他们会稍微延迟发病时间。

It's maybe a year if you use it for a long time from what the data shows.

从数据来看，如果长期使用的话，可能是一年的时间。

So women who suppress ovulation, we lose about 11,000 eggs each month with the ovulation process to get one out 11,000 race to the finish line, and only one makes it.

因此，抑制排卵的女性，在排卵过程中每个月会失去大约 11,000 个卵子，只有 11,000 人能跑到终点线，只有 1 人能成功。

But we lose about 11,000 in the process.

但在此过程中我们损失了大约 11,000 人。

So women who are constantly for a long time suppressing ovulation will have a slightly older age of menopause.

所以长期不断抑制排卵的女性，绝经年龄会稍大一些。

Had they not done that.

如果他们没有这样做的话。

Andrew Huberman:

安德鲁·休伯曼：

When you say slightly older, what's the longest extension of the

当你说稍微老一点的时候，最长的延伸是多少？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Best I could see in the data was maybe nine months

我在数据中看到的最好时间可能是九个月

Andrew Huberman:

安德鲁·休伯曼：

From nine months use of

从使用九个月起

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Birth control?

节育？

No. So maybe like five to 10 year use.

不会。所以也许可以使用五到十年。

I have to look at the data again.

我得再看一遍数据。

I'd have to look that one up, but it was several years.

我必须查一下那个，但已经好几年了。

Andrew Huberman:

安德鲁·休伯曼：

Got it.

明白了。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

To gain an extra maybe nine months, maybe a year of ovarian life.

为了获得额外的也许九个月，也许一年的卵巢寿命。

Andrew Huberman:

安德鲁·休伯曼：

I see.

我明白了。

And nowadays, at least if people have the means, there's some trend, if you will, toward freezing one's eggs, this might be a good opportunity to just state something that came up before when we had Dr. Natalie Crawford on the podcast to talk about female fertility, I think surprising to many people was her statement that not because it's controversial, but because we just don't hear this often enough that harvesting eggs for freezing or for IVF does not diminish the pool of eggs that one would have.

现在，至少如果人们有办法的话，有一些趋势，如果你愿意的话，冷冻卵子，这可​​能是一个很好的机会来陈述之前我们让娜塔莉·克劳福德博士在播客上谈论女性生育能力时出现的一些事情，我认为令很多人惊讶的是她的声明，不是因为它有争议，而是因为我们只是没有经常听到这样的说法：收集卵子用于冷冻或体外受精并不会减少人们拥有的卵子库。

Meaning you're losing them each month anyway.

这意味着无论如何你每个月都会失去它们。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Yeah.

是的。

And so they're only pulling out, I dunno, 10, 12 maybe in a cycle and when you're losing 11,000 with an ovulation.

所以他们只会退出，我不知道，可能在一个周期中10、12，当你在排卵期间失去11,000时。

So it really isn't going to affect when you go through menopause,

所以当你经历更年期时它真的不会影响，

Andrew Huberman:

安德鲁·休伯曼：

Such a crucial thing for people to hear.

对于人们来说，这是至关重要的事情。

I think there were a number of comments when we posted that clip on social media and people, women saying, wow, I didn't realize that harvesting eggs would not somehow shift the onset of menopause earlier.

我想当我们在社交媒体上发布这段视频时，人们发表了很多评论，女性们说，哇，我没有意识到采集卵子不会以某种方式提前改变更年期的开始。

And so for the record, we are not saying that we're saying that it does not, and very interesting that the use of birth control, but I'm guessing only forms of birth control that suppress ovulation population can delay the onset of perimenopause menopause by about nine months, maximum.

因此，郑重声明，我们并不是说没有，而且非常有趣的是使用节育措施，但我猜测只有抑制排卵人口的节育形式才能将围绝经期的开始时间最多延迟约九个月。

Maximum.

最大限度。

So things like the copper IUD

像铜宫内节育器这样的东西

Mary Claire Haver:

玛丽·克莱尔·哈弗：

That won't

那不会

Andrew Huberman:

安德鲁·休伯曼：

Affect it, right, which prevent pregnancy by creating a unfavorable environment for the sperm rather than disrupting ovulation in any way will not presumably extend perimenopause menopause.

影响它，对吧，通过为精子创造不利的环境而不是以任何方式破坏排卵来防止怀孕，大概不会延长围绝经期的更年期。

Okay.

好的。

Just want to make sure we're crystal clear for people.

只是想确保我们对人们来说一目了然。

You're being very clear, but I want to make sure that I'm clear on it.

你说得很清楚，但我想确保我说得很清楚。

And then reiterate, because this can be kind of tricky territory.

然后重申，因为这可能是一个棘手的领域。

I think there are a lot of assumptions about this stuff and there's a lot of lore out there.

我认为关于这些东西有很多假设，并且有很多传说。

Why do you think that is?

你认为这是为什么？

Is that because of the lack of solid research and communication in this area?

是因为这方面缺乏扎实的研究和交流吗？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

I think so.

我想是的。

Andrew Huberman:

安德鲁·休伯曼：

Or is it something else?

或者是别的什么？

I think that these are tricky topics for discussion often because we hear all this stuff like birth control pills, disrupt one's ability to get pregnant when they come off, or we just learned that it can delay the onset of perimenopause, which by extension means there's a greater window for pregnancy if one thinks about it that way.

我认为这些都是经常讨论的棘手话题，因为我们听到诸如避孕药之类的东西，避孕药脱落后会破坏一个人的怀孕能力，或者我们刚刚了解到它可以推迟围绝经期的开始，这意味着如果人们这样想的话，怀孕的窗口期会更大。

But why do you think it's such a tangled discussion out there?

但你认为为什么会有如此混乱的讨论呢？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

I think just the way that society views pregnancy and female health, and at least I live on the internet now.

我认为这就是社会看待怀孕和女性健康的方式，至少我现在生活在互联网上。

This new life has brought me life on the internet, and this is what the algorithms are showing me.

这种新的生活给我带来了互联网上的生活，这就是算法向我展示的。

Andrew Huberman:

安德鲁·休伯曼：

It's a very friendly, everyone's written, everyone loves

这是一个非常友好的，每个人都写的，每个人都喜欢

Mary Claire Haver:

玛丽·克莱尔·哈弗：

You.

你。

Andrew Huberman:

安德鲁·休伯曼：

It's a great listen.

这是一个很棒的聆听。

It's what you're doing is so important.

你正在做的事情是如此重要。

And I understand the statement behind that statement, I think, but it's so important because people are getting the opportunity to learn about really critical public health and female health issues in a way that just was inaccessible before.

我认为我理解该声明背后的声明，但这非常重要，因为人们有机会以以前无法获得的方式了解真正重要的公共卫生和女性健康问题。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Yeah, it is.

是的，确实如此。

And it's good and bad.

这有好有坏。

There's a lot of lore and misinformation that's getting propagated.

有很多传说和错误信息正在传播。

And I feel like as a specialty, as a women's health specialist, we did this to ourselves.

我觉得作为一名专业人士，作为一名女性健康专家，我们对自己做了这件事。

We have not properly educated ourselves.

我们没有正确地教育自己。

We have not spent the money.

我们还没有花过钱。

The research really championed women after reproduction.

这项研究确实支持了生育后的女性。

When you look at the dollars and the research and where it goes in women's health, I mean, women's health just gets a little sliver of all the NIH funding.

当你看看资金和研究以及它在女性健康方面的应用时，我的意思是，女性健康只得到了美国国立卫生研究院所有资金的一小部分。

When you look at all NIH funding and what goes to menopause, it's 0.03%, less than half a percent.

当你看看 NIH 的所有资助以及用于更年期的资金时，你会发现它是 0.03%，不到半个百分点。

This is one third of a woman's life.

这是女人一生的三分之一。

And when you look at God, McKinsey and Company just published a report where they pulled 680 studies on chronic diseases, diabetes, hypertension, cardiovascular disease, and they looked at how they were women included in the studies, but how many presented the data for the different sexes, like what happened to men versus what happened to women?

当你看看上帝时，麦肯锡公司刚刚发布了一份报告，他们提取了 680 项关于慢性病、糖尿病、高血压、心血管疾病的研究，并研究了女性如何纳入研究中，但有多少提供了不同性别的数据，比如男性的情况与女性的情况？

It was only 50% of the articles actually did sex specific differences and how this medication affected this process or whatever.

只有 50% 的文章实际上讨论了性别差异以及这种药物如何影响这一过程等。

And then the ones that did 30% of women had poorer outcomes, and on the flip side, 10% of men had poorer outcomes.

然后，对 30% 的女性进行治疗的结果较差，而另一方面，对 10% 的男性进行治疗的结果较差。

And these things aren't just being brought to light.

这些事情不仅仅被曝光。

So the lack of recognition of sex specific differences in chronic disease and how menopause kind of plays into all that, I think is where the future needs to go.

因此，我认为，缺乏对慢性疾病中性别差异的认识，以及更年期如何影响这一切，这就是未来的发展方向。

So we deserve as much good health as everyone else.

因此，我们应该像其他人一样拥有良好的健康。

Yes, we're living longer than men, but 20 to 25% of that life is in poor health.

是的，我们的寿命比男性长，但其中 20% 到 25% 的时间健康状况不佳。

Andrew Huberman:

安德鲁·休伯曼：

Wow.

哇。

That's a really significant statement.

这是一个非常重要的声明。

I mean, I think that the National Institutes of Health has been terrific in establishing new institutes within it.

我的意思是，我认为美国国立卫生研究院在内部建立新的研究所方面做得非常出色。

They even have a complimentary health institute now.

他们现在甚至还有一个免费的健康机构。

There's the National Eye Institute, there's cancer here.

这里有国家眼科研究所，这里有癌症。

Is there a plan or one would hope for a dedicated institute for women's health a push?

是否有计划或希望建立一个专门致力于妇女健康的机构来推动？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

So there was one piece of legislation that got pushed through the Biden signed it, and it was a hundred million dollars for women's health, and that got chopped up very quickly.

因此，拜登签署了一项法案，该法案是为了妇女健康而推动的一亿美元，但很快就被砍掉了。

And menopause did get a little piece of it because we're also really struggling with endometriosis and a lot of the female specific uterine diseases and PCOS and things, and so we need more funding there as well.

更年期确实受到了影响，因为我们也确实在与子宫内膜异位症和许多女性特有的子宫疾病和多囊卵巢综合症等问题作斗争，所以我们也需要更多的资金。

Then there's another bill that just got, that's the one.

然后还有另一份账单刚刚收到，就是这个。

Halle Berry was on TV talking about another bill for $250 million.

哈莉·贝瑞 (Halle Berry) 在电视上谈论另一笔 2.5 亿美元的账单。

That bill includes language for education of providers.

该法案包括提供者的教育语言。

We have a whole generation of providers.

我们拥有整整一代的提供商。

I graduated my residency training the year the WHI came out.

WHI 发布那年，我完成了住院医师培训。

So all we had very little real clinically significant menopause education, and then we knew about HRT and we were giving it in clinic if she was coming in with severe hot flashes.

因此，我们几乎没有接受过真正具有临床意义的更年期教育，然后我们了解了激素替代疗法，如果她出现严重潮热，我们就会在诊所进行治疗。

But that got taken off the table after the WHI, and then we have a whole gener all menopause education basically stopped

但在 WHI 之后，这个问题就被取消了，然后我们就基本上停止了所有更年期教育

Andrew Huberman:

安德鲁·休伯曼：

After that.

之后。

So WHI, women's Health Initiative, HRT, sorry.

所以，WHI、女性健康倡议、HRT，抱歉。

No, that's okay.

不，没关系。

Just so that people are on board hormone replacement therapy.

只是为了让人们接受激素替代疗法。

Yeah, well, we can encourage the expansion of research in these areas and with this discussion, and certainly I was on NIH panels for years as a regular member in the I institute.

是的，通过这次讨论，我们可以鼓励扩大这些领域的研究，当然，我作为 I 研究所的正式成员，多年来一直在 NIH 小组中工作。

And what I've noticed with NIH is that they are very responsive to the public call for growth of research in particular areas.

我注意到美国国立卫生研究院对公众要求在特定领域开展研究的呼声做出了非常积极的回应。

It can take time.

这可能需要时间。

It's government after all, and they need funding.

毕竟是政府，他们需要资金。

There's a finite amount of funding.

资金是有限的。

But I think that rarely do I ever get into legislature based things, but if you are somebody who cares about more funding in a given area of research, it's actually very straightforward what to do.

但我认为我很少涉及基于立法机构的事情，但如果你是关心在特定研究领域获得更多资金的人，那么实际上做什么是非常简单的。

You call your congressman or senator and you tell them literally you leave a message.

你打电话给你的国会议员或参议员，然后告诉他们你确实留言了。

I find this kind interesting.

我觉得这种很有趣。

So it's kind of like what we learned in social studies and in elementary school, but you call your senator or your governor and you leave a message and you say, Hey, there's this issue that impacts a ton of people and it's really important.

这有点像我们在社会研究和小学中学到的东西，但是你打电话给你的参议员或州长，你留言说，嘿，这个问题影响了很多人，它非常重要。

And the next time it comes up, when budgeting comes up in Washington, it's really important.

下次当华盛顿提出预算时，它真的很重要。

And if you hear about a bill, you can call and support a bill.

如果您听说有账单，您可以致电并支持账单。

And believe it or not, some of that stuff actually translates to more funding in a given area.

不管你信不信，其中一些东西实际上可以转化为特定领域的更多资金。

In fact, that brain initiative, which unfortunately had its budget cut significantly recently, maybe put that funding back, but arose from the, I believe it was the child of two neuroscience professors up at University of Wisconsin.

事实上，不幸的是，最近预算大幅削减的大脑计划可能会收回这笔资金，但它是由威斯康星大学两位神经科学教授的孩子产生的。

I'm probably going to get some details wrong.

我可能会弄错一些细节。

So the kils are the professors, as I recall, and their son hood, all of these conversations growing up about the importance of brain science and then eventually pushed through government channels for more money for brain research.

所以我记得，基尔是教授和他们的儿子，所有这些关于脑科学重要性的对话，然后最终通过政府渠道为脑研究争取更多资金。

And then we had a long phase of pretty substantial research and then it was cut.

然后我们进行了很长一段时间的相当实质性的研究，然后就被削减了。

So these things, but it persists.

所以这些事情，却依然存在。

And so these things really matter.

所以这些事情真的很重要。

They do.

他们确实这么做了。

They can impact it.

他们可以影响它。

And maybe we should send them a clip of your statements on this podcast, getting back to things that people can control.

也许我们应该向他们发送您在这个播客上的发言片段，回到人们可以控制的事情上。

So for people who are heading into perimenopause or who are in the perimenopause phase, aside from the typical things that we hear about, fortunately a lot these days, like getting adequate sleep, getting exercise, nutrition, maybe we could touch a little bit on nutrition in a moment.

因此，对于即将进入围绝经期或正处于围绝经期阶段的人来说，除了我们听到的典型事情之外，幸运的是，现在有很多事情，比如充足的睡眠、锻炼、营养，也许我们可以稍后接触一下营养。

You mentioned Mediterranean diet, Galveston diet, things that are going to promote overall health.

你提到了地中海饮食、加尔维斯顿饮食，这些都会促进整体健康。

Are there any things that people can do, maybe even take that would improve their outcomes in this phase?

人们可以做、甚至可以采取哪些措施来改善这一阶段的结果？

I've heard of people, and I have no bias here or even knowledge of the research on this, if there is any people taking, for instance, grape seed extract or people trying to do a number of things to reduce inflammation, kind of general themes around self-care and wellness these days, but what are sort of the five or six that come to mind perhaps as the things that can move the levers in the right direction?

我听说过有人，我对此没有偏见，甚至对这方面的研究不了解，例如，是否有人服用葡萄籽提取物或有人试图做一些事情来减少炎症，这些都是当今自我保健和健康的普遍主题，但我想到的五六种可能是哪些东西可以将杠杆推向正确的方向？

What

什么

Mary Claire Haver:

玛丽·克莱尔·哈弗：

I would tell my 30 5-year-old self who just kind of went into this obliviously and what I know now is your diet is probably one of the most important things that determines your level of inflammation.

我会告诉 30 5 岁的自己，他只是不知不觉地进入了这个状态，而我现在知道的是，你的饮食可能是决定你炎症程度的最重要因素之一。

And then estrogen is a really powerful anti-inflammatory hormone, and we lose that protection when we start losing it through the transition.

雌激素是一种非常强大的抗炎激素，当我们在过渡过程中开始失去这种保护时，我们就会失去这种保护。

So whatever you can do in the other areas, especially with nutrition, sleep, stress reduction, we need to do it.

因此，无论您在其他领域可以做什么，特别是在营养、睡眠、减轻压力方面，我们都需要这样做。

So fiber, we are not getting enough fiber in our diet and the western diet, I think most women are getting 10 to 12 grams per day and we need at least 25.

所以纤维，我们的饮食和西方饮食中没有摄入足够的纤维，我认为大多数女性每天摄入 10 到 12 克，而我们至少需要 25 克。

And the health benefits tend to max out around 30, 32 grams per day.

每天摄入 30 至 32 克对健康有益。

So focusing on foods that are rich in fiber fiber's, feeding the gut microbiome, slowing down glucose levels, sugar absorption into the bloodstream, it is slowing down the rate of certain parts of transit and pulling more water into the gut.

因此，关注富含纤维的食物，喂养肠道微生物群，减缓血糖水平，减缓血液中糖的吸收，它会减慢某些部分的运输速度，并将更多的水吸入肠道。

There's nothing bad about it.

这没什么不好的。

The foods that are rich in fiber have a lot of other stuff that's good for you too.

富含纤维的食物还含有许多其他对您有益的物质。

Cofactors, vitamins, minerals, nutrient, just they're just so healthful.

辅因子、维生素、矿物质、营养素，它们非常健康。

And then antho, cyan, just find things that crunch and get as many colors as you can.

然后是花色、青色，找到可以压缩的东西并获得尽可能多的颜色。

Green, red, purple, yellow, every color represents a phytochemical that is going to be good for you in different areas of your body.

绿色、红色、紫色、黄色，每种颜色都代表一种植物化学物质，对您身体的不同部位都有好处。

And try to keep it as varied as possible.

并尽量保持多样化。

We're not getting enough protein, and I have to thank Dr. Gabrielle Lyon really helping me focus in on that.

我们没有获得足够的蛋白质，我必须感谢加布里埃尔·里昂博士真正帮助我专注于这一点。

When I first wrote Galveston Diet, to be honest and transparent, it was for weight loss and I was frustrated with my weight gain and that was the pain point my patients had, and that was my pain point.

当我第一次写《加尔维斯顿饮食法》时，老实说，这是为了减肥，我对体重增加感到沮丧，这是我的患者的痛点，也是我的痛点。

But I didn't realize it represented something much more sinister than just the way I looked, the visceral fat gain.

但我没有意识到这代表着比我看起来更危险的东西，即内脏脂肪增加。

And so learning about visceral fat and what it really means, and that is for your listeners, the fat that wraps around our internal organs, it's a very different fat than the subcutaneous fat.

因此，了解内脏脂肪及其真正含义，这对于您的听众来说，包裹着我们内脏的脂肪，它是一种与皮下脂肪非常不同的脂肪。

And a premenopausal women we age matched and looked at visceral fat levels measuring it with the DEXA scanners, you have about 8% of your fat is visceral as a premenopausal person.

与我们年龄相匹配的绝经前女性，使用 DEXA 扫描仪测量内脏脂肪水平，发现作为绝经前女性，大约 8% 的脂肪是内脏脂肪。

And then when you go through the transition, it's 23% with no changes in diet and exercise.

当你经历转变时，在饮食和锻炼没有改变的情况下，这个比例是 23%。

Andrew Huberman:

安德鲁·休伯曼：

The visceral fat is not something that gets enough attention.

内脏脂肪并没有得到足够的重视。

I think everyone thinks about subcutaneous fat because it's related,

我想每个人都会想到皮下脂肪，因为它是相关的，

Mary Claire Haver:

玛丽·克莱尔·哈弗：

It's cosmetically distressing, but really, yeah.

虽然看起来很不美观，但确实如此。

Andrew Huberman:

安德鲁·休伯曼：

And one doesn't want too much of it for health reasons either, but it's the intra visceral fat that at least by my understanding, is really the most problematic for our

出于健康原因，人们也不想要太多，但至少据我了解，内脏脂肪对我们来说确实是最大的问题。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Health.

健康。

It's a harbinger of chronic disease.

这是慢性病的预兆。

So

所以

Andrew Huberman:

安德鲁·休伯曼：

I read that weight gain is one of the primary symptoms of menopause itself.

我读到体重增加是更年期本身的主要症状之一。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

So you have to be careful how you think about that.

所以你必须小心你的想法。

When we plot weight gain versus age, it's a very straightforward linear curve, and menopause does not seem to affect that.

当我们绘制体重增加与年龄的关系时，这是一条非常简单的线性曲线，更年期似乎不会影响这一点。

What is happening is a body composition change.

正在发生的是身体成分的变化。

We are losing muscle and we are gaining visceral fat, and you might be gaining some subcutaneous fat, but those are kind of the key things that are happening.

我们正在失去肌肉，我们正在增加内脏脂肪，你可能会增加一些皮下脂肪，但这些是正在发生的关键事情。

And so that's really, when I'm counseling patients, what I'm focusing on.

因此，当我为患者提供咨询时，这确实是我关注的重点。

I have a body scanner in my office where I can tell them what their level of visceral fat is in their muscle mass.

我的办公室里有一台身体扫描仪，我可以告诉他们肌肉质量中的内脏脂肪水平。

And so we bone and muscle, that musculoskeletal unit works together.

所以我们的骨骼和肌肉，即肌肉骨骼单位一起工作。

And so we see this acceleration of muscle loss, which controls our basal metabolic rate, which determines our resistance to insulin, which, so it's just, that's the organ of longevity.

所以我们看到肌肉流失的加速，它控制着我们的基础代谢率，决定了我们对胰岛素的抵抗力，这就是长寿的器官。

That's what I've learned from Dr. Lyon and everything we can do to hang onto it and build is so important.

这就是我从里昂博士那里学到的东西，我们可以做的一切来坚持和建设是非常重要的。

So protein, going back to the original point, protein intake is key and women by and large are getting 50 to 60 grams of protein per day, and we really probably need 80, a hundred, 120 depending on our body composition.

所以蛋白质，回到最初的观点，蛋白质的摄入量是关键，大多数女性每天摄入 50 到 60 克蛋白质，根据我们的身体成分，我们可能真的需要 80 克、100 克、120 克蛋白质。

Andrew Huberman:

安德鲁·休伯曼：

Yeah, thanks for mentioning Dr. Gabrielle and she's doing what I view as just

是的，谢谢你提到加布里埃尔博士，她正在做我认为正确的事情

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Beautiful work in

美丽的工作在

Andrew Huberman:

安德鲁·休伯曼：

The world.

世界。

Yeah, terrific work.

是的，很棒的工作。

Really promoting women's health and health generally.

真正促进女性健康和普遍健康。

I know now I believe it's exploring advanced training in urology for males as well.

我现在知道我相信它也在探索针对男性的泌尿外科高级培训。

And so it's only fair to credit her with really expanding into these different areas, but especially this idea that we need and women perhaps in particular, from what I understand, she'll be on the podcast soon, so we'll get more of an understanding at least one gram of quality protein per pound of lean body mass, maybe per pound of body weight per day in order to optimize their health.

因此，公平地说，相信她确实扩展到了这些不同的领域，但尤其是我们需要的这个想法，尤其是女性，据我了解，她很快就会出现在播客上，所以我们将更多地了解每磅瘦体重，也许每天每磅体重至少一克优质蛋白质，以优化她们的健康。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Yeah, she's definitely on the higher end.

是的，她绝对是高端的。

The WHR, the Women's Health Initiative, some of my favorite data, it's not all bad, it's data and was looking at frailty scores and protein intake and women.

WHR，女性健康倡议，一些我最喜欢的数据，它并不全是坏事，它是数据，并且正在研究衰弱分数和蛋白质摄入量以及女性。

And what they found was women who were having 1.5 to 1.7, so basically it was the higher their protein intake, the less likely they were to be frail, the end.

他们发现女性的蛋白质摄入量为 1.5 到 1.7，所以基本上来说，她们的蛋白质摄入量越高，她们身体虚弱的可能性就越小。

And they were reaching, it was kind of peaking out somewhere around 1.5 to 1.7 grams for kilogram of lean body mass.

他们的去脂体重达到了 1.5 至 1.7 克左右的峰值。

And most women are getting the FDA recommends 0.8.

大多数女性的 FDA 建议值为 0.8。

Andrew Huberman:

安德鲁·休伯曼：

Wow.

哇。

And source of protein also important.

蛋白质的来源也很重要。

High quality.

高质量。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

You need all the amino acids.

你需要所有的氨基酸。

Andrew Huberman:

安德鲁·休伯曼：

Yeah, very interesting.

是的，非常有趣。

Now that's in menopause, but presumably also.

现在已经进入更年期了，但大概也是如此。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

So starting those habits in peri, just getting that laid down and getting those habits laid down are going to set you up for a much better post menopause, a much healthier post menopause.

因此，在围绝经期开始这些习惯，只要养成这些习惯，养成这些习惯，就能让您在更年期后过得更好、更健康。

And we have to stop defining menopause by your hot flashes.

我们必须停止用潮热来定义更年期。

It may or may not make your hot flashes better, and we have great medications for that if it's disruptive.

它可能会或可能不会使你的潮热症状得到缓解，如果它具有破坏性，我们有很好的药物来治疗。

But I'm talking about your cardiometabolic disease risk.

但我说的是你的心脏代谢疾病风险。

Andrew Huberman:

安德鲁·休伯曼：

I meant to ask this earlier, so forgive me for leaping back briefly, but is there any value in knowing the age at which your mother went into menopause?

我本来想早点问这个问题，所以请原谅我暂时跳回来，但是了解你母亲进入更年期的年龄有什么价值吗？

Tremendous

巨大的

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Genetic

遗传

Andrew Huberman:

安德鲁·休伯曼：

As a metric or a sensor rather, or as a window into whether or not you will go into menopause at more or less the same age?

作为一个指标或传感器，或者作为了解您是否会在大致相同的年龄进入更年期的窗口？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Yes, there is a, of course, it's not one-to-one, we get half of our DNA from our fathers.

是的，当然，这不是一对一的，我们有一半的 DNA 来自我们的父亲。

But I always ask, and there is the latest data that looked at it.

但我总是问，有最新的数据来看。

Genetics is the biggest factor that determines when you're going to go through menopause.

遗传是决定您何时进入更年期的最大因素。

So knowing when your mother's, your aunts went through and if there were any medical conditions associated with that is huge.

因此，了解你的母亲、你的阿姨何时经历过，以及是否有任何与之相关的医疗状况是非常重要的。

Andrew Huberman:

安德鲁·休伯曼：

Okay, so now we're talking not so much about perimenopause, but also menopause itself.

好吧，现在我们谈论的不是围绝经期，而是更年期本身。

What is the typical constellation of symptoms as one enters menopause right at the beginning and then does that constellation of symptoms change as one is a year or two years, three years into

当一个人一开始就进入更年期时，典型的一系列症状是什么，然后这些症状在一年、两年、三年后会发生变化吗？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Menopause?

更年期？

So it's almost a hundred percent with body composition changes, very, very close.

所以身体成分的变化几乎是百分之一百，非常非常接近。

That visceral fat is tough to beat.

内脏脂肪很难被击败。

It's beatable, but it takes a lot of work.

它是可以击败的，但需要做很多工作。

Do

做

Andrew Huberman:

安德鲁·休伯曼：

People know if they have visceral fat?

人们知道自己是否有内脏脂肪吗？

I mean there's their scanning approaches to

我的意思是他们的扫描方法

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Look at it.

看看它。

Of course, the gold standard is AA or even an MRI, but no one can afford that.

当然，黄金标准是 AA 甚至 MRI，但没有人负担得起。

So we have, what I have in my office is the InBody scanner.

我办公室里有 InBody 扫描仪。

So it's electrical impedance scanner, and it's pretty good.

所以它是电阻抗扫描仪，而且非常好。

Andrew Huberman:

安德鲁·休伯曼：

So you stand on the scale, hold the handles,

所以你站在秤上，握住手柄，

Mary Claire Haver:

玛丽·克莱尔·哈弗：

And I have the medical, the highest grade one for my patients, and most people doing what I do utilizing a body scanner, use that one.

我有医疗级的，为我的病人提供的最高级别的扫描仪，大多数像我一样使用人体扫描仪的人都使用那个扫描仪。

But you can use the waist tip ratio.

但你可以使用腰尖比例。

And so the waist tip ratio is a better measure of your risk of metabolic health than your weight or your BMI.

因此，腰围比是比体重或体重指数更好的衡量代谢健康风险的指标。

So it's so simple.

所以就这么简单。

You take a tape measure and a calculator, you can do it in your head, but you measure the smallest part of your waist.

你拿卷尺和计算器，你可以在脑子里做，但你要测量腰部最小的部分。

And if you don't have a small waist, if it goes out, then just use your belly button.

而如果你没有小腰，如果它出去了，那就用你的肚脐吧。

Just use something you can measure again,

只需使用可以再次测量的东西，

Andrew Huberman:

安德鲁·休伯曼：

Are people sucking in or are they relaxed?

人们是在沉浸还是放松？

You

你

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Should be relaxed.

应该放松。

And I tell my patients, do it first thing in the morning when your bladder's empty and you're not bloated, and then the widest part of your hips.

我告诉我的病人，早上第一件事就是在你的膀胱排空并且你没有浮肿的时候做，然后是你臀部最宽的部分。

It's not perfect, but it's better than your weight or your BMI.

它并不完美，但比您的体重或体重指数要好。

Andrew Huberman:

安德鲁·休伯曼：

So widest part of the hips with people with feet parallel.

所以臀部最宽的部分与人的脚平行。

Parallel, trying to up people.

平行，努力向上的人。

People are going to go try this, right?

人们会去尝试这个，对吧？

And

并且

Mary Claire Haver:

玛丽·克莱尔·哈弗：

So I only know the data for women, so forgive me.

所以我只知道女性的数据，请见谅。

But for a female, if it's less than 0.7, then your chance of having clinically significant aberrations in visceral fat are low.

但对于女性来说，如果低于 0.7，那么内脏脂肪出现具有临床意义的显着异常的机会就很低。

And then if it's greater than one, you likely have higher levels of visceral fat.

如果它大于一，则您的内脏脂肪水平可能较高。

And so in clinic, or when I was coaching online for Galveston diet, we were using the waist up ratio as one of the measures for their success.

因此，在临床上，或者当我在网上指导加尔维斯顿饮食时，我们使用腰部以上比例作为衡量成功的标准之一。

Andrew Huberman:

安德鲁·休伯曼：

When measuring the waist, which point along the waist is it right at the navel?

测量腰围时，腰部哪一点正好在肚脐处？

Is it,

是吗，

Mary Claire Haver:

玛丽·克莱尔·哈弗：

It's just wherever you're smallest.

就在你最小的地方。

So that's kind of different for different women.

所以这对于不同的女性来说是不同的。

So I would just say, look in the mirror, wherever your hourglass goes in is where you want to kind of stick to.

所以我想说，照照镜子，你的沙漏进入的地方就是你想要坚持的地方。

But if you don't have that kind of a waist and you have a wider waist, just pick the belly button.

但如果你没有那样的腰，而且腰比较宽，就挑肚脐吧。

You always know you can go back to that level.

你总是知道你可以回到那个水平。

Tracking them over time.

随着时间的推移跟踪他们。

Andrew Huberman:

安德鲁·休伯曼：

Great.

太棒了。

Those are very useful recommendations.

这些都是非常有用的建议。

And how often should people do that?

人们应该多久这样做一次？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

You should never weigh yourself every day.

您永远不应该每天称体重。

You shouldn't do this every day.

你不应该每天都这样做。

We were having patients do it or our followers do it once a month.

我们让病人或我们的追随者每月做一次。

Andrew Huberman:

安德鲁·休伯曼：

So changes in body composition as measured by DEXA or impedance or you don't have acid or waist ratio, waist to hip ratio.

因此，通过 DEXA 或阻抗测量的身体成分变化，或者您没有酸或腰围比、腰臀比。

What are some of the other symptoms of menopause?

更年期还有哪些其他症状？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Fatigue.

疲劳。

Fatigue.

疲劳。

Multiple causes For the fatigue.

多种原因导致疲劳。

A lot of sleep disruption.

睡眠受到很多干扰。

Sleep disruption is another huge thing.

睡眠中断是另一件大事。

So all of a sudden you're struggling to go to sleep or you're having middle of the night awakenings and not able to go back to bed

突然之间，您难以入睡，或者半夜醒来，无法回到床上

Andrew Huberman:

安德鲁·休伯曼：

That are new and different from

这是新的并且不同于

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Previous new and different than before.

以前是新的，与以前不同。

I see there was a recent study that came out and most of my patients in hindsight say, I knew something wasn't right or something was different.

我看到最近发表了一项研究，我的大多数患者事后都说，我知道有些东西不对劲或者有些东西不同。

Something had changed, but I couldn't put my finger on it.

有些事情发生了变化，但我无法指出它。

And they just had a study come out saying, when they looked at what that means, what does I'm not feeling like myself mean?

他们刚刚发表了一项研究，当他们研究这意味着什么时，我感觉不像自己是什么意思？

And it was psychological changes.

这是心理上的变化。

So you lose resilience, you're suddenly more irritable, you're suddenly not able to go with the punches or you're not adjusting as well to change that.

所以你会失去韧性，你会突然变得更加烦躁，你会突然无法接受打击，或者你不会做出调整来改变这一点。

You used to.

你曾经这样。

You're snapping at your kids more.

你对你的孩子更加严厉。

You're partner or you, you're getting frustrated at work.

无论您是伴侣还是您自己，您都会在工作中感到沮丧。

It's just very kind of subtle and it takes going through it and then looking back to say, yeah, I really say maybe about 47 that something was changing and I just thought I was just stressed out, whatever.

这是非常微妙的，需要经历它，然后回过头来说，是的，我真的说，也许大约 47 岁的时候，有些事情正在发生变化，我只是觉得我只是压力太大了，无论如何。

And then now can see that was the beginning of the pattern.

现在可以看到，这就是该模式的开始。

So menstrual changes, as we talked about the big highlights, vertigo, tinnitus, ringing in the ears, skin changes, so dry skin, itchy skin, feeling like you're having crawling under the skin, big gut changes.

所以月经的变化，正如我们谈到的大亮点，眩晕，耳鸣，耳鸣，皮肤变化，皮肤干燥，皮肤发痒，感觉就像在皮肤下爬行，肠道发生巨大变化。

So new onset bloating, you're kind of eating all the same things and your gut's just not handling things like it used to.

所以新出现的腹胀，你吃的都是同样的东西，而你的肠道只是不再像以前那样处理东西了。

So the Zoey nutrition study took 1100 women and did stool samples through menopause, through the perimenopause menopause transition, and saw the changes in the gut microbiome from the loss of the sex hormones.

因此，Zoey 营养研究对 1100 名女性进行了更年期、围绝经期和更年期过渡期间的粪便样本，观察了肠道微生物组因性激素丧失而发生的变化。

And basically we went from what a typical female microbiome to that of a male through the transition.

基本上，我们从典型的女性微生物组转变为男性微生物组。

Andrew Huberman:

安德鲁·休伯曼：

Is there any direct evidence that supplementing the gut microbiome?

有没有直接证据表明可以补充肠道微生物组？

And here I don't necessarily mean pills and powders.

这里我不一定指的是药丸和粉末。

I mean, my understanding is that getting a fiber and low sugar fermented foods can also support the gut microbiome.

我的意思是，我的理解是，摄入纤维和低糖发酵食品也可以支持肠道微生物组。

Things like sauerkraut, kimchi,

比如酸菜，泡菜，

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Miso, keefer,

味噌、泡酒、

Andrew Huberman:

安德鲁·休伯曼：

Miso,

味噌，

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Plain yogurt, just straight up, nothing added.

原味酸奶，直接喝，没有添加任何东西。

Andrew Huberman:

安德鲁·休伯曼：

Yeah.

是的。

So is there evidence that supporting the gut microbiome can make this stage of menopause more, I guess reduce some of the symptoms of menopause?

那么是否有证据表明支持肠道微生物组可以使更年期的这个阶段变得更加，我想可以减轻更年期的一些症状？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

So the best I could find was most of them are done with supplements.

所以我能找到的最好的办法是大多数都是通过补充剂完成的。

Those are easier to measure than handing someone a cup of yogurt

这些比递给某人一杯酸奶更容易测量

Andrew Huberman:

安德鲁·休伯曼：

And which bacteria you're providing.

以及您提供的细菌。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

So they did lactobacillus and looked and bifido bacterium I think, and saw that women who were obese and hypertensive in menopausal and they had visceral fat decrease in blood pressure improvements versus placebo.

因此，他们研究了乳酸菌，并观察了双歧杆菌，我认为，发现更年期肥胖和高血压的女性与安慰剂相比，血压有所改善，内脏脂肪减少。

Also, it's hard to do placebo studies with food, but they do.

此外，很难用食物进行安慰剂研究，但确实如此。

And then in the retrospective studies they can look at dietary patterns and women who ate rich foods, fermented and lots of yogurt, Mediterranean type diets have better symptoms overall.

然后在回顾性研究中，他们可以观察饮食模式，吃丰富食物、发酵食物和大量酸奶、地中海式饮食的女性总体症状更好。

Andrew Huberman:

安德鲁·休伯曼：

What's the difference between the Mediterranean diet and the Galveston diet?

地中海饮食和加尔维斯顿饮食有什么区别？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

So I got my culinary medicine certification.

所以我获得了烹饪医学认证。

I was

我是

Andrew Huberman:

安德鲁·休伯曼：

Frustrated culinary medicine,

沮丧的烹饪医学，

Mary Claire Haver:

玛丽·克莱尔·哈弗：

So I was frustrated when I was working because I didn't know anything about nutrition.

所以我在工作时很沮丧，因为我对营养一无所知。

And suddenly everything I was trying to tell my patients was based on the one lecture I got in medical school and good nutrition was like porn when you see it, the Supreme Court definition of pornography.

突然之间，我试图告诉我的病人的一切都基于我在医学院接受的一次讲座，当你看到它时，良好的营养就像色情片，最高法院对色情片的定义。

And so the best I'd ever gotten was the gestational diabetic diet and it was the Xerox things with, I was in Texas, so it had tortillas and stuff on it, and it had been copied so many times, you could barely read it anymore.

所以我得到的最好的就是妊娠糖尿病饮食，它是施乐的东西，我在德克萨斯州，所以上面有玉米饼和其他东西，而且它已经被复制了很多次，你几乎无法再阅读它了。

And that was the diet.

这就是饮食。

That was the only nutrition I'd ever handed to a patient.

这是我给病人的唯一营养品。

And so I'm eat healthy and so I'm like, I got to do better than this.

所以我吃得健康，所以我想，我必须做得更好。

I don't know enough.

我还不够了解。

And so we had a guest speaker for Alpha Omega Alpha, which is the Honor Society for Medical School, and I was one of the advisors and it was this guy, Tim Harlan, who had started this culinary movement and it was basically nutrition for doctors.

因此，我们有一位 Alpha Omega Alpha（医学院荣誉协会）的客座演讲者，我是顾问之一，蒂姆·哈兰（Tim Harlan）发起了这场烹饪运动，基本上是为医生提供营养。

And he developed this online program and I had to go to New Orleans for a lab at San Antonio for a lab and work in kitchens where you were learning how to counsel patients, how to cook, and also basically getting a little minor in nutrition.

他开发了这个在线程序，我必须去新奥尔良的一个实验室，在圣安东尼奥的一个实验室，在厨房工作，在那里你学习如何为病人提供咨询，如何做饭，基本上还辅修了一点营养学。

So it was the best thing I've ever done.

所以这是我做过的最好的事情。

It

它

Andrew Huberman:

安德鲁·休伯曼：

Was to say very cool.

可以说非常酷了。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

I mean I learned about allergies and all this stuff, food allergies and things that I just didn't know and just basic nutritional principles, what it takes to build a healthy body.

我的意思是，我了解了过敏和所有这些东西，食物过敏和我不知道的事情，以及基本的营养原则，以及如何建立健康的身体。

I knew about kco and severe deficiencies, but not good basic nutrition.

我了解 kco 和严重缺乏症，但不了解良好的基本营养。

They talked heavily about Mediterranean, they talked a lot about the fad diets and stuff, but the principles of the Mediterranean, I was like, I want to teach this to my patients, but they're not going to eat a lot of Greek yogurt or they're probably not going eat a lot of feta.

他们大量谈论地中海饮食，谈论了很多时尚饮食之类的东西，但是地中海的原则，我想，我想向我的患者传授这一点，但他们不会吃很多希腊酸奶，或者他们可能不会吃很多羊乳酪。

How can I take these blocks and make it more Americanized?

我怎样才能利用这些街区并使其更加美国化？

So that was kind of like the brainchild for me around Galveston diet was let me create something.

所以这有点像我围绕加尔维斯顿饮食的创意，让我创造一些东西。

And I really was into fasting at the time too, so I was like, let me put this fasting thing together with good nutritional, anti-inflammatory principles and talk about the things we know, or probably you should not having a whole lot of processed foods and high sugars and stuff and explain it in a way and how it's affecting their menopause and how can she approach her nutrition.

当时我也真的很喜欢禁食，所以我想，让我把禁食和良好的营养、抗炎原则放在一起，谈谈我们知道的事情，或者你不应该吃大量的加工食品和高糖之类的东西，并以某种方式解释它，以及它如何影响他们的更年期，以及她如何摄入营养。

And that's how Galveston diet was born.

这就是加尔维斯顿饮食法的诞生。

It was for my patients and then I gave it to my girlfriends and then they started sharing it and I talked about it one day on Facebook and the world exploded

这是给我的病人的，然后我把它给了我的女朋友，然后她们开始分享它，有一天我在 Facebook 上谈论了它，世界爆炸了

Andrew Huberman:

安德鲁·休伯曼：

In the best

在最好的情况下

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Way.

方式。

In the best way.

以最好的方式。

Yeah, it led me here

是的，它引导我来到这里

Andrew Huberman:

安德鲁·休伯曼：

And we all benefit.

我们都受益。

What is the evidence that fasting can be beneficial or detrimental to perimenopause menopause?

有什么证据表明禁食对围绝经期有益或有害？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Yeah, so the jury's kind of still out on that one.

是的，所以陪审团对此还没有定论。

I was really liked the data that I think it was Mark Matson had done on neurodegenerative disease and using fasting as a tool there and lowering inflammation levels.

我真的很喜欢马克·马特森在神经退行性疾病方面所做的数据，并使用禁食作为一种工具来降低炎症水平。

So I was like, this is amazing.

所以我想，这太棒了。

This is great because so much about menopause is pro-inflammatory

这很棒，因为更年期有很多促炎症因素

Andrew Huberman:

安德鲁·休伯曼：

Is this intermittent fasting, so time

这就是间歇性禁食吗，所以时间

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Restrictive, feeding you inter.

限制性的，给你喂食。

So he was basically doing 16 eight and very scheduled intermittent fasting.

所以他基本上是在进行16-8并且非常有计划的间歇性禁食。

And so that was something I was coaching my followers about, consider this try this might be something to help lower inflammation.

这就是我正在指导我的追随者的事情，考虑一下这次尝试，这可能有助于减轻炎症。

I've pulled back on that because it's really hard to get enough protein in for a lot of women, especially if they came in at 60 and now I'm telling them to double their protein and then giving them an eight hour window to do it.

我已经收回了这一点，因为对于很多女性来说，摄入足够的蛋白质确实很困难，特别是如果她们在 60 岁时才摄入，现在我告诉她们将蛋白质加倍，然后给她们八小时的时间来做到这一点。

They're like, I'm walking around.

他们就像，我在四处走动。

No, I'm on a chicken breast all day.

不，我整天都在吃鸡胸肉。

This is hard.

这很难。

Andrew Huberman:

安德鲁·休伯曼：

And metabolizing protein is its own work,

而代谢蛋白质是它自己的工作，

Mary Claire Haver:

玛丽·克莱尔·哈弗：

And so you have to spread it out throughout the day.

所以你必须把它分散到全天。

And a lot of that work was done at U-T-M-B-E where I did my undergrad, I mean my residency and where I taught for years.

其中很多工作都是在 U-T-M-B-E 大学完成的，我在那里完成了本科学业，我的意思是我的住院医师实习以及我教书多年的地方。

And so I was friendly with the nutrition department there.

所以我和那里的营养部门很友好。

I was getting all excited about everything and they were like, I went to several their conferences and talking about breaking up protein intake into nuggets throughout the day because most women have very little protein with breakfast, maybe wheat, gluten in their toast and then have a little bit at lunch and then kind of stack their protein at night and they're still not getting enough, but they're overdoing it in their evening meal.

我对一切都感到非常兴奋，他们说，我参加了几次他们的会议，谈论全天将蛋白质摄入量分解为块状，因为大多数女性早餐中的蛋白质很少，也许是小麦，吐司中含有麸质，然后午餐吃一点，然后在晚上增加蛋白质，但她们仍然没有摄入足够的蛋白质，但她们在晚餐中摄入过多。

That's their big protein meal.

那是他们的大蛋白质餐。

And so teaching them to kind of what I was teaching in Galveston diet was you need to have a healthy fat, a good healthy carb and a protein with every meal and snack that you eat.

因此，教他们我在加尔维斯顿饮食中所教的内容是，你需要在每顿饭和零食中含有健康的脂肪、良好的健康碳水化合物和蛋白质。

Andrew Huberman:

安德鲁·休伯曼：

Why do you think that protein has not been emphasized enough until recently?

您认为为什么直到最近蛋白质才受到足够的重视？

I

我

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Think because we didn't understand it, we didn't understand how important muscle was.

想想因为我们不了解它，我们不了解肌肉有多重要。

And I mean, we knew that protein intake was important for muscle, but muscle was for bodybuilders and not for women.

我的意思是，我们知道蛋白质摄入量对肌肉很重要，但肌肉是针对健美运动员的，而不是针对女性的。

I lived my whole life up until about five years ago, eating to be thin and moving to be thin, that thin was the only measurement of health that I needed to worry about.

直到大约五年前，我的一生都是为了瘦而吃，为了瘦而运动，瘦是我唯一需要担心的健康衡量标准。

And what I did was chip away at my bone and muscle strength and thank God I don't have osteopenia yet.

我所做的就是削弱我的骨骼和肌肉力量，感谢上帝，我还没有骨质减少。

I've hopefully have reversed whatever trend I was on and I'm naturally low muscle.

我希望已经扭转了我的趋势，而且我天生肌肉含量低。

So now it's just a battle to try to hang on to what little I have and build some

所以现在这只是一场战斗，试图坚持我所拥有的一点点，并建立一些

Andrew Huberman:

安德鲁·休伯曼：

You resistance train.

你阻力训练。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Yeah.

是的。

Andrew Huberman:

安德鲁·休伯曼：

Now three days a week, three days a week, three

现在一周三天，一周三天，三天

Mary Claire Haver:

玛丽·克莱尔·哈弗：

To four days a week.

每周工作四天。

Yeah, I'm resistance training, much less cardio.

是的，我正在进行阻力训练，更不用说有氧运动了。

I was running marathons and it was a great social thing with my girlfriends, but everything I did was cardio.

我正在跑马拉松，这对我的女朋友来说是一件很棒的社交活动，但我所做的一切都是有氧运动。

I taught step aerobics.

我教踏步健美操。

The only weights I did were maybe in Zumba, maybe one or two pounds, and that was better than being on the couch.

我唯一做的重量可能是在尊巴舞中，可能是一两磅，这比躺在沙发上要好。

I mean, I loved the community and doing that, but for me to stay out of the nursing home, which was my ultimate goal for as long as possible, I need to pick up some weights and heavy weights.

我的意思是，我热爱这个社区并这样做，但为了让我尽可能长时间地远离疗养院，这是我的最终目标，我需要举起一些重量和大重量。

So that's where my focus has changed.

这就是我的关注点发生了变化的地方。

Andrew Huberman:

安德鲁·休伯曼：

Isn't it interesting that it wasn't until recently that it was only bodybuilders and football players and people preparing for military or specific sport would resistance train and now we are told that everybody, male, female, young, old, should resistance training?

有趣的是，直到最近，只有健美运动员、足球运动员以及准备军事或特定运动的人才会进行阻力训练，而现在我们被告知，每个人，无论男性、女性、年轻人、老年人，都应该进行阻力训练？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Absolutely.

绝对的。

Andrew Huberman:

安德鲁·休伯曼：

Probably three times a week.

大概每周三次。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

And my generation is struggling because we don't know how to do it, and I'm not a personal trainer.

我们这一代人正在苦苦挣扎，因为我们不知道该怎么做，而且我也不是私人教练。

I don't pretend I hire one to help me develop a program so that I don't hurt myself and that I can't get stronger progressive load.

我不会假装雇了一个人来帮助我开发一个程序，这样我就不会伤害自己，也不会获得更强的渐进负荷。

So again, Dr. Lyon's such a huge proponent of that.

再说一遍，里昂博士是这一点的大力支持者。

And so what I try to do publicly is show my workouts so that people, I normalize it and people see me doing it and they're like, well, she can do it, then I can do it.

所以我试图公开做的就是展示我的锻炼，以便人们，我将其正常化，人们看到我这样做，他们就像，好吧，她可以做到，然后我也可以做到。

Andrew Huberman:

安德鲁·休伯曼：

That's great.

太好了。

Super inspiring.

超级鼓舞人心。

And it really helps cross that threshold where people, as you said, they don't know how, it's scary for people with resistance trained for a long time.

它确实有助于跨越这个门槛，正如你所说，人们不知道如何做到这一点，这对于长期接受抵抗训练的人来说是可怕的。

They go into a gym, they know how all that stuff works, but for those that don't

他们走进健身房，他们知道所有这些东西是如何运作的，但对于那些不知道的人

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Wandering around, what does this one do?

转了一圈，这个是做什么的？

It's

这是

Andrew Huberman:

安德鲁·休伯曼：

Intimidating for a whole bunch of reasons.

由于种种原因而令人生畏。

Well, thank you for putting that content out, both the prescription if you will, but also the example that one can go about it.

好吧，感谢您发布这些内容，如果您愿意的话，既可以提供处方，也可以提供可以实施的示例。

So I'm guessing if you could go back 20 years, you would've started resistance training earlier and eating more.

所以我猜如果你能回到20年前，你会更早开始阻力训练并且吃得更多。

Yeah.

是的。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Stronger skinny nutrition over calories and stop trying to look a certain way.

加强瘦身营养而不是卡路里，并停止试图以某种方式看起来。

You're undermining your future health by doing that.

这样做会损害你未来的健康。

Andrew Huberman:

安德鲁·休伯曼：

I'd like to take a quick break and acknowledge our sponsor Inside Tracker.

我想稍微休息一下并感谢我们的赞助商 Inside Tracker。

Inside Tracker is a personalized nutrition platform that analyzes data from your blood and DNA to help you better understand your body and help you reach your health goals.

Inside Tracker 是一个个性化营养平台，可分析您的血液和 DNA 数据，帮助您更好地了解您的身体并帮助您实现健康目标。

Now, I've long been a believer in getting regular blood work done for the simple reason that many of the factors that impact your immediate and long-term health can only be analyzed from a quality blood test.

现在，我长期以来一直相信定期进行血液检查，原因很简单，影响您当前和长期健康的许多因素只能通过高质量的血液测试来分析。

Now, a major problem with a lot of blood tests out there is that you get information back about metabolic factors and hormones and lipids and so forth, but you don't know what to do with that information.

现在，大量血液测试的一个主要问题是，您获得有关代谢因素、激素和脂质等的信息，但您不知道如何处理这些信息。

With Inside Tracker, they make it very easy to know what to do with those numbers because they have a personalized platform that allows you to see the levels of those metabolic factors, lipids, hormones, et cetera, and they give you specific directives that you can follow related to nutrition, behavioral modification, supplementation and more.

通过 Inside Tracker，他们可以很容易地知道如何处理这些数字，因为他们有一个个性化的平台，可以让您查看这些代谢因素、脂质、激素等的水平，并且他们为您提供与营养、行为改变、补充等相关的具体指示，您可以遵循这些指示。

That can help you bring those numbers into the ranges that are optimal for you.

这可以帮助您将这些数字调整到最适合您的范围。

If you'd like to try inside Tracker, you can go to inside tracker.com/huberman to get 10% off.

如果您想尝试 inside Tracker，可以访问 inside tracker.com/huberman 享受 10% 的折扣。

Their new membership program Inside Tracker membership offers significantly reduced prices on inside tracker's, comprehensive blood panels.

他们的新会员计划 Inside Tracker 会员资格大幅降低了 inside tracker 综合血液检测的价格。

Again, that's inside tracker.com/huberman to get 10% off.

同样，在 tracker.com/huberman 内可享受 10% 的折扣。

So what are some other symptoms of menopause?

那么更年期还有哪些其他症状呢？

You mentioned body composition changes.

您提到了身体成分的变化。

The one that we hear about the most for some reason I don't know, is hot

出于某种我不知道的原因，我们听到最多的一个是热门

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Flashes.

闪烁。

So maybe we can define, I

所以也许我们可以定义，我

Andrew Huberman:

安德鲁·休伯曼：

Think

思考

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Hot flashes in medicine, we call it a vasomotor symptom.

潮热在医学上，我们称之为血管舒缩症状。

So we have a dysregulation of the thermo regulatory center in the hypothalamus and the thermostat gets reset basically.

因此，我们的下丘脑温度调节中心出现了失调，恒温器基本上会被重置。

And so what happens is we have this vasodilation of, it starts in the core typically for most women somewhere in the chest, neck area, and you feel this heat, I can probably trigger one just by talking about it and it goes up into the neck and out into the extremities, and then you just start profusely sweating from all the blood vessels dilating, and then it can last minutes to a second.

所以我们会发生这种血管舒张，对于大多数女性来说，它通常从胸部、颈部区域的核心部位开始，你会感觉到这种热量，我可能只是通过谈论它就可以触发一种热量，它会上升到颈部并延伸到四肢，然后你开始因所有血管扩张而大量出汗，然后它可以持续几分钟到一秒钟。

But for some women it's preceded by sometimes palpitations, sometimes by this intense feeling of dysphoria, this intense sadness feeling, and then it just kind of passes.

但对于一些女性来说，这之前有时会出现心悸，有时会出现这种强烈的烦躁感，这种强烈的悲伤感，然后就过去了。

But say you're wherever you are in your life, whatever you're doing, all of a sudden you're just sweating profusely in the middle of some important area of your life, work, whatever your jobs are in your life, and it's disruptive.

但是，假设你在生活中的任何地方，无论你在做什么，突然间你在生活、工作、无论你的工作是什么的某个重要领域中大汗淋漓，这是破坏性的。

If it happens at night, you don't sleep.

如果它发生在晚上，你就无法入睡。

And for some women, it's severe where they're having multiple ones a day.

对于一些女性来说，一天多次怀孕的情况会很严重。

Andrew Huberman:

安德鲁·休伯曼：

Anytime you disrupt sleep, then daytime is far worse.

任何时候你扰乱睡眠，白天的情况都会更糟。

Regulation of

监管

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Everybody differently.

每个人都不同。

Yeah, you stress differently.

是的，你的压力不同。

Everything changes.

一切都变了。

When my patients come in, the first questions we ask are sleep.

当我的病人进来时，我们问的第一个问题就是睡眠。

That's the first thing we work on is what can we do to get your sleep better?

我们要做的第一件事是我们能做些什么来让您的睡眠更好？

Andrew Huberman:

安德鲁·休伯曼：

What can be done for hot flashes aside from the things that you've already described to offset menopause?

除了您已经描述过的缓解更年期症状的方法之外，还可以采取哪些措施来治疗潮热？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Absolute gold standard is hormone therapy is giving your body back the estrogen, which will readjust, get your serotonin levels back to where they were and leave that thermo regulatory center alone.

激素疗法的绝对黄金标准是让您的身体恢复雌激素，雌激素会重新调整，使您的血清素水平恢复到原来的水平，并且不影响体温调节中心。

So it's back to where it used to be.

于是又回到了原来的位置。

Andrew Huberman:

安德鲁·休伯曼：

Let's talk about hormone therapy.

我们来谈谈激素治疗。

Sure.

当然。

It's a bit of a controversial topic for no reason.

这是一个无缘由的有争议的话题。

Yeah, I was going to say I don't know why.

是的，我正想说我不知道​​为什么。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Yeah, it's demonized.

是的，它被妖魔化了。

It got such a bad rap and we need to, it's just some of the, what was the worst misinformation campaign in the history of medicine?

它的名声如此糟糕，我们需要这样做，这只是医学史上最严重的错误信息活动的一部分？

Andrew Huberman:

安德鲁·休伯曼：

Well, that's a bold statement, but I believe you, the way I understand it is that there was this large scale hormone therapy trial, and the interpretation of that trial was something different than we now believe as a medical immunity.

嗯，这是一个大胆的声明，但我相信你，我的理解是，有过一次大规模的激素治疗试验，对该试验的解释与我们现在认为的医学免疫不同。

The

的

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Initial, it was really groundbreaking at the time.

最初，这在当时确实是开创性的。

Aging women were finally being studied.

老年女性终于得到了研究。

We knew from observational data that women on hormone therapy, probably 40% of the population of females eligible were on HRT.

我们从观察数据中得知，接受激素治疗的女性中，可能有 40% 的符合条件的女性接受了 HRT。

So very large amount.

所以数量非常大。

So the women who were given hormone therapy had lower incidents of cardiovascular disease, older ages of cardiovascular disease, lower death from cardiovascular disease.

因此，接受激素治疗的女性心血管疾病发生率较低，心血管疾病发病年龄较大，心血管疾病死亡率较低。

Some people argued that that was an artifact of healthier, wealthier women get HRT because they go to the doctor.

一些人认为，这是更健康、更富有的女性因去看医生而接受激素替代疗法的产物。

So this is just because they're healthier, that they have less cardiovascular disease.

所以这只是因为他们更健康，心血管疾病更少。

So let's prove it.

那么让我们来证明一下。

What do you do that with a randomized control trial?

您如何通过随机对照试验来做到这一点？

So flaws in the study.

所以研究中存在缺陷。

So they take, I think there were 11,000 ish women in the estrogen only arm.

所以他们认为，我认为有 11,000 名左右的女性接受纯雌激素治疗。

They'd had hysterectomy.

他们接受了子宫切除术。

So for your listeners, if you have a uterus and you're getting estrogen, you must have a progestogen with it to protect the lining of the uterus from endometrial cancer.

因此，对于听众来说，如果您有子宫并且正在服用雌激素，那么您必须同时服用孕激素来保护子宫内膜免受子宫内膜癌的侵害。

As long as you give an adequate progestin, you're fine.

只要你给予足够的孕激素，就没有问题。

But if you don't have a uterus, progesterone is not mandatory.

但如果你没有子宫，黄体酮就不是强制性的。

So the women who had had hysterectomy got estrogen only or placebo.

因此，接受子宫切除术的女性只服用雌激素或安慰剂。

And the estrogen at the time was Premarin, which was the number one prescription for HRT at the time.

而当时的雌激素是倍美力（Premarin），是当时HRT的第一大处方。

So nothing weird about that.

所以这没什么奇怪的。

Okay, so

好吧，那么

Andrew Huberman:

安德鲁·休伯曼：

It's just synthetic estradiol.

它只是合成雌二醇。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Actually, no, Premarin is, Premarin stands for pregnant marere urine.

事实上，不，倍力马是，倍力马代表怀孕母马尿液。

It is actually very natural.

这实际上是非常自然的。

They take pregnant horses and extract the estrogens from their urine because they're pregnant and they were reading a lot of it, and it was cheap and easy, and I have a lot of ethical issues about how they do that, and I don't prescribe it, but that's what was done at the time.

他们从怀孕的马身上提取雌激素，因为它们怀孕了，而且她们读了很多东西，而且便宜又容易，我对他们如何做到这一点有很多道德问题，我没有开处方，但这就是当时所做的。

Andrew Huberman:

安德鲁·休伯曼：

I've seen horses urinate.

我见过马撒尿。

They urinate a lot.

他们小便很多。

There were dozen.

有十几个。

I didn't realize those there.

我没有意识到那里有那些。

Race horse, right?

赛马，对吧？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

There's dozens of estrogens in that, but the main one is estradiol.

其中含有数十种雌激素，但主要的是雌二醇。

So then the other group who had uterus were given prempro, which is Premarin plus Provera or placebo.

然后另一组有子宫的人接受 prempro，即倍美力加 Provera 或安慰剂。

So off we go, they recruit 11,000 and then I think 15,000 in the other arm.

所以我们开始吧，他们招募了 11,000 人，然后我认为另一支队伍也招募了 15,000 人。

Huge study.

巨大的研究。

It was like a billion dollar study.

这就像一项耗资十亿美元的研究。

We're so excited this is happening.

我们非常兴奋这件事的发生。

And this started when I was in med school, and then they start recruiting patients and then everyone's taking their meds.

这开始于我在医学院的时候，然后他们开始招募患者，然后每个人都在服用药物。

They excluded women with hot flashes.

他们排除了患有潮热的女性。

Andrew Huberman:

安德鲁·休伯曼：

What?

什么？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Because if your pop flashes go away, you know that you didn't get the placebo.

因为如果你的闪光消失了，你就知道你没有服用安慰剂。

So they excluded one with hot flashes, problem number one.

因此他们排除了患有潮热的第一个问题。

Andrew Huberman:

安德鲁·休伯曼：

Yeah, that's a big problem.

是的，这是一个大问题。

Now,

现在，

Mary Claire Haver:

玛丽·克莱尔·哈弗：

The end outcome, what they were trying to measure was cardiovascular disease.

他们试图测量的最终结果是心血管疾病。

So they started with an older population.

所以他们从老年人口开始。

The average age was 63,

平均年龄63岁，

Andrew Huberman:

安德鲁·休伯曼：

Whereas the typical onset of menopause is

而更年期的典型开始时间是

Mary Claire Haver:

玛丽·克莱尔·哈弗：

51.

51.

Wow.

哇。

So these women had been menopausal on average for 10, 12, 13 years.

所以这些女性平均绝经时间为 10 年、12 年、13 年。

So time away from estrogen is when disease starts accelerates.

因此，远离雌激素的时间就是疾病开始加速的时候。

Right.

正确的。

Okay.

好的。

So put them on their meds, start measuring in the estrogen plus progestin arm, they saw a statistically significant increased risk of breast cancer.

因此，让他们服用药物，开始测量雌激素加孕激素组，他们发现患乳腺癌的风险在统计上显着增加。

And it was this, the relative risk relative.

这就是相对风险。

Now you know what this is, but your money or your listeners may not was 25%, and I hope I get the numbers.

现在你知道这是什么了，但你的钱或你的听众可能不是 25%，我希望我能得到这些数字。

It was four out of a thousand women per year to five out of a thousand women per year.

每年千分之四到千分之五的女性。

So placebo arm was four.

所以安慰剂组是四组。

So we have breasts, we are females, we get breast cancer, about four out of a thousand women per year, and that increased to five in the estrogen only arm.

因此，我们有乳房，我们是女性，每年大约有千分之四的女性患乳腺癌，而在仅使用雌激素的群体中，这一比例增加到了五人。

There was a 30% decreased risk of breast cancer regardless

不管怎样，患乳腺癌的风险降低了 30%

Andrew Huberman:

安德鲁·休伯曼：

Of the average age.

平均年龄。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

And they kept that arm going

他们让手臂继续前进

Andrew Huberman:

安德鲁·休伯曼：

Because randomized.

因为随机。

So presumably the average age for the other group is roughly 61

所以推测另一组的平均年龄约为 61 岁

Mary Claire Haver:

玛丽·克莱尔·哈弗：

As well.

也是如此。

Yeah, they were matched, so in their sixties as well.

是的，他们很般配，所以也是六十多岁了。

So they call a press conference at the Watergate Hotel,

所以他们在水门酒店召开了新闻发布会

Andrew Huberman:

安德鲁·休伯曼：

The Watergate Hotel of all places, two

所有地方的水门酒店，两个

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Ounce, the findings, they hadn't even published the data yet.

盎司，调查结果，他们甚至还没有公布数据。

No one had a chance to read it.

没有人有机会读它。

And the head researchers call this press conference and say, estrogen causes breast cancer,

首席研究人员在这次新闻发布会上说，雌激素会导致乳腺癌，

Andrew Huberman:

安德鲁·休伯曼：

Exogenous estrogen from these.

外源性雌激素来自这些。

Yes,

是的，

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Yes.

是的。

And they said it's a 25% increase risk, but the absolute risk was like 0.8% per year.

他们说风险增加了 25%，但绝对风险每年大约增加 0.8%。

But that's not a headline thing.

但这不是头条新闻。

So on every A-B-C-N-B-C-C-B-S, all the morning shows, nightly news, every major magazine, it was the number one medical news story of 2002 that estrogen was bad and it caused cancer and dah, dah, dah.

因此，在每一个 A-B-C-N-B-C-C-B-S、所有早间节目、晚间新闻、每一份主要杂志上，2002 年头号医学新闻报道都是雌激素有害，它会导致癌症，等等。

The estrogen only arm kept going and they found after a couple more years, a slightly increased risk of stroke.

仅使用雌激素的手臂继续坚持下去，几年后他们发现中风的风险略有增加。

So they stopped the study.

所以他们停止了研究。

The effects on cardiovascular disease were neutral, but there was lower colon cancer in both groups, but no one talked about that.

对心血管疾病的影响是中性的，但两组的结肠癌发病率均较低，但没有人谈论这一点。

So the American Heart Association in 2020 went and looked at, they looked at ages.

所以美国心脏协会在 2020 年去考察了，他们考察了各个年龄段。

So there were younger women who were given HRT, and what they found was if you started hormone therapy between the ages of 50 to 59, you had a 50% decreased risk of cardiovascular disease and death from cardiovascular disease and all cause mortality.

因此，有一些年轻女性接受了 HRT，他们发现，如果您在 50 至 59 岁之间开始激素治疗，您患心血管疾病以及死于心血管疾病和全因死亡率的风险会降低 50%。

Andrew Huberman:

安德鲁·休伯曼：

Wow.

哇。

So age at which you start

那么你开始的年龄

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Matters matters estrogen.

重要的是雌激素。

So that's where there's something called the healthy cell hypothesis.

这就是所谓的健康细胞假说。

And so basically estrogen is better at prevention than cure and it's very protective, especially in the tima of the coronary arteries.

因此，基本上雌激素的预防作用胜于治疗作用，并且具有很强的保护作用，尤其是在冠状动脉的蒂玛。

So taking that estrogen away, we lose that protection once the disease builds up.

因此，如果去掉雌激素，一旦疾病加重，我们就会失去这种保护。

There's some worry that adding estrogen, once you've developed atherosclerosis or a plaque might loosen the plaque, especially in that first year, which led for some people maybe to have a slightly increased risk of stroke.

有人担心，一旦出现动脉粥样硬化或斑块，添加雌激素可能会使斑块松动，尤其是在第一年，这可能会导致某些人中风的风险略有增加。

So when my patients come in, we are talking about these differences.

因此，当我的患者进来时，我们正在讨论这些差异。

It doesn't mean that after 60 you might not have cardiovascular benefit, we start losing the benefit.

这并不意味着 60 岁之后您可能不再对心血管有益，而是我们开始失去这种益处。

So it's the timing hypothesis is key and it's the years away from estrogen.

因此，时间假设是关键，距离雌激素的使用还有几年。

That's the problem.

这就是问题所在。

It was a great study in the British Medical Journal.

这是《英国医学杂志》上发表的一项伟大的研究。

They looked at years of reproductive life plus HRT and looked at cognition scores and saw that the longer your body's exposed to estrogen in any form, like whether natural cycles or exogenous estrogen of any form, and it was estradiol in that study actually, then you had higher cognition scores, healthier brains, which

他们观察了生育寿命加上激素替代疗法（HRT）的年数，并观察了认知得分，发现你的身体接触任何形式的雌激素（例如自然周期或任何形式的外源雌激素）的时间越长，实际上该研究中是雌二醇，那么你的认知得分就越高，大脑就越健康，这

Andrew Huberman:

安德鲁·休伯曼：

At a just very top contour level makes total sense given that estrogen is neuroprotective, I realize might not be neuroprotective in every instance and every neuron in the brain, but it's generally

考虑到雌激素具有神经保护作用，在最顶层的轮廓水平上完全有意义，我意识到可能不会在每个实例和大脑中的每个神经元中都具有神经保护作用，但它通常是

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Neuroprotective.

神经保护。

Generally neuroprotective,

一般具有神经保护作用，

Andrew Huberman:

安德鲁·休伯曼：

Yeah.

是的。

And decline in estrogen is correlated with neurodegeneration, which does not mean it's causal.

雌激素的下降与神经退行性疾病相关，但这并不意味着它是因果关系。

I have to ask, when they announced this study at the Watergate Hotel of all places, and the conclusion that they put forth was that estrogen therapies can increase rates of cancer.

我不得不问，当他们在各地的水门酒店宣布这项研究时，他们提出的结论是雌激素疗法会增加癌症发病率。

I have to wonder if that had something to do with What I understand is the sort of party line around cancers in breast cancers in particular, which is that you want to quote block the estrogen receptor.

我想知道这是否与我所理解的关于乳腺癌的党派路线有关，尤其是乳腺癌，那就是你想引用阻断雌激素受体的说法。

You want to get in there and give tamoxifen or nowadays, I'm sure there are other drugs that are more effective to block the estrogen receptor.

你想进去服用他莫昔芬，或者现在，我确信还有其他药物可以更有效地阻断雌激素受体。

It all seems to pile up on the side of a story that says estrogen and estrogen binding to the estrogen receptor is precancerous, which obviously I think you're telling us in an indirect, indirect way now and we'll go further into is simply not the case.

这一切似乎都堆积在一个故事的侧面，即雌激素和雌激素与雌激素受体结合是癌前病变，显然我认为你现在正在以间接的方式告诉我们，我们将进一步探讨事实并非如此。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

If you take a healthy breast cell and dump it at a Petri dish and then marinate it with some estrogen, it's not teratogen, it's not carcinogenic.

如果你将健康的乳腺细胞倒入培养皿中，然后用一些雌激素腌制，它就不会致畸，也不会致癌。

Estrogen is not carcinogenic.

雌激素不致癌。

We live with it our whole lives.

我们一生都与它共存。

If it was in pregnancy, for those of us who are ever pregnant, when our estrogen levels skyrocket, we would see this into uptick in breast cancer.

如果是在怀孕期间，对于我们这些曾经怀孕过的人来说，当我们的雌激素水平飙升时，我们会看到乳腺癌发病率上升。

And we don't.

但我们不这样做。

Andrew Huberman:

安德鲁·休伯曼：

In fact, I think there's some evidence for the opposite that getting pregnant prior to age 40, is it true that that's protective against certain

事实上，我认为有一些相反的证据表明，在 40 岁之前怀孕，这真的可以预防某些疾病吗？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Forms of breast that seems to be somewhat protective for certain forms of breast cancer?

哪种类型的乳房似乎对某些形式的乳腺癌有一定的保护作用？

Yeah, so we have this whole generation of physicians who really weren't taught much about menopause, don't understand the protective benefits of estrogen and menopause is effect on metabolic disease, and they have this mentality of estrogen is bad.

是的，我们这一代医生确实没有受过太多关于更年期的教育，不了解雌激素的保护作用，也不了解更年期对代谢疾病的影响，他们有这种雌激素不好的心态。

And so a woman walks into her today, 2023, they looked at the data, she goes into her doctor complaining of menopausal symptoms, which right now are still only recognized as general urinary syndrome, menopause, hot flashes, night sweats, the very cliche symptoms, documents in the charts she's having whatever, only 10% are offered any therapy and they're most likely four to one to be offered an antidepressant.

因此，2023 年的今天，一名女性走进她的诊所，他们查看了数据，她向医生抱怨更年期症状，这些症状目前仍然只被认为是一般泌尿系统综合症、更年期、潮热、盗汗，这些非常陈词滥调的症状，她所拥有的图表中的文件，只有 10% 的人接受了任何治疗，而他们最有可能接受抗抑郁药物的比例是四比一。

That is where it stands today.

这就是今天的情况。

That is what we are fighting against is not every woman will choose HRT, but every woman deserves an informed conversation about it and let her make her choice.

这就是我们所反对的，不是每个女性都会选择激素替代疗法，但每个女性都应该对此进行知情的对话，并让她做出自己的选择。

If you believe the WHI data, which there are some problems there, the risk is small, but did you talk to her about cardiovascular disease and diabetes and insulin resistance and her cholesterol because those things go up through the menopause transition with no changes in diet and exercise.

如果你相信 WHI 数据，那里存在一些问题，那么风险很小，但是你有没有和她谈论心血管疾病、糖尿病、胰岛素抵抗和她的胆固醇，因为这些东西会在更年期过渡期间上升，而饮食和锻炼没有改变。

And those are all, even with the diagnosis of breast cancer, the most likely thing a woman is going to die from is cardiovascular disease, a heart attack or a stroke.

综上所述，即使诊断出乳腺癌，女性最有可能死于心血管疾病、心脏病或中风。

So framing it like that I think is where we need to head.

所以我认为这样的框架是我们需要前进的方向。

And the other thing is, I was a great OBGYN and so many areas of what I did, why should this all be dumped in the lap of the poor busy OB gyn who's running around the hospital doing pap smears, trying to deliver babies surgery and all the things this should be required education for everyone in medical school.

另一件事是，我是一名出色的妇产科医生，我做了很多领域的工作，为什么这一切都应该被扔到可怜的忙碌的妇产科医生的腿上，她在医院里跑来跑去，做子宫颈抹片检查，试图接生手术，以及所有这些应该是医学院每个人都需要接受的教育。

We are females and we're not little men with breast and uterus.

我们是女性，我们不是有乳房和子宫的小男人。

We react differently to medications, disease, disease burden.

我们对药物、疾病、疾病负担的反应不同。

And that's not been studied adequately.

这还没有得到充分研究。

And that's where the push needs to go.

这就是需要推动的地方。

It's bigger than just hot flashes.

它比潮热更严重。

Andrew Huberman:

安德鲁·休伯曼：

Do you think that one solution is to deepen the medical school curriculum?

您认为深化医学院课程是解决方案之一吗？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Absolutely.

绝对的。

And more, and I hate saying women's health because everyone thinks breast and uterus and reproduction.

还有更多，我讨厌说女性健康，因为每个人都认为乳房、子宫和生殖。

It's the health of women and we're not addressing it differently than the health of a man.

这是女性的健康问题，我们的处理方式与男性的健康没有什么不同。

And we're different.

而我们不同。

And so that I think is where we need to head.

我认为这就是我们需要前进的方向。

Andrew Huberman:

安德鲁·休伯曼：

Given that it's half of the population, one would imagine that the best thing to do is to make the core curriculum of medical students expand to include this as opposed to making it a specialty.

鉴于它占人口的一半，人们会认为最好的办法是扩大医学生的核心课程，将其纳入其中，而不是使其成为一门专业。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

I think

我认为

Andrew Huberman:

安德鲁·休伯曼：

So.

所以。

Does that mean a fifth year of medical school?

这是否意味着医学院第五年？

I'm not kidding.

我不是在开玩笑。

I mean, I guess

我的意思是，我猜

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Maybe.

也许吧。

I mean, people said, well, you'd have to extend the OB GYN residency.

我的意思是，人们说，好吧，你必须延长妇产科住院医师的期限。

I'm like, no. Any specialist who touches a female should understand how that female, I mean, the starkest example is cardiovascular disease.

我想，不。任何接触女性的专家都应该了解女性，我的意思是，最明显的例子是心血管疾病。

How much longer we have to wait in the ed, how much more likely we are to die in the hospital setting from a heart attack because we don't present the same symptoms as men do.

我们需要在急诊室等待多长时间，我们在医院死于心脏病的可能性有多大，因为我们没有表现出与男性相同的症状。

And it's just the default has always been how it happens to the basic really Caucasian male.

对于普通的白人男性来说，这一直是默认情况。

And so at least in the us.

至少在美国是这样。

And so because we respond differently, because we wait longer because our symptoms are considered to be psychologically induced, less than biologically induced.

因为我们的反应不同，因为我们等待的时间更长，因为我们的症状被认为是心理诱发的，而不是生物诱发的。

And so women are dying at higher rates.

因此，女性的死亡率更高。

When you look at the data on statins, you get high cholesterol.

当你查看他汀类药物的数据时，你会发现胆固醇很高。

So 80% of women will have abnormal cholesterol levels through the men.

所以80%的女性会通过男性出现胆固醇水平异常。

Im post transition if they were normal before.

如果他们之前正常的话，我就是过渡后的。

Okay, so

好吧，那么

Andrew Huberman:

安德鲁·休伯曼：

Elevated

高架

Mary Claire Haver:

玛丽·克莱尔·哈弗：

L-D-L-L-D-L and lowering HDL.

L-D-L-L-D-L 并降低 HDL。

So now they are at higher risk for cardiovascular disease automatically A PCP will offer her a statin that is standard of care.

因此，现在他们患心血管疾病的风险自动增加，PCP 将为她提供标准护理的他汀类药物。

Do you know that the American Heart Association published in 2020 that statins have never been shown to decrease their primary heart attack in a woman?

您是否知道美国心脏协会在 2020 年发表的文章称，他汀类药物从未被证明可以减少女性原发性心脏病发作？

Secondary, yes, but no primary prevention and it does not decrease the risk of death from cardiovascular disease.

是的，是次要预防，但没有一级预防，也不会降低心血管疾病死亡的风险。

I did not know that.

我不知道。

Yeah.

是的。

Yet, you know, what does HRT if given in the right window of opportunity,

然而，你知道，如果在正确的机会窗口内进行 HRT，会产生什么作用，

Andrew Huberman:

安德鲁·休伯曼：

How is the HRT in this case, estrogen, HRT given?

这种情况下HRT，雌激素，HRT是如何给予的？

Is it a patch?

是补丁吗？

Is it injections?

是注射吗？

Is it

是吗

Mary Claire Haver:

玛丽·克莱尔·哈弗：

A pill?

一颗药丸？

Pill?

丸？

Yeah, great question.

是的，很好的问题。

All the above.

以上全部。

So we have, I like to break it down into oral and non-oral forms.

所以我们有，我喜欢将其分为口头和非口头形式。

So everything oral we ingest goes into the gut, the liver, the hepatic system will pick up the portal vein and take everything to the liver for processing.

因此，我们口服摄入的所有食物都会进入肠道、肝脏，肝脏系统会通过门静脉将所有食物带到肝脏进行处理。

When that bump of estrogen hits the liver, we can see a slight increase in some of our clotting factors.

当雌激素冲击肝脏时，我们可以看到一些凝血因子略有增加。

So for that reason, I tend to go with the non-oral formulations to avoid that risk, especially if she has any family history of clotting or personal history of clotting, we're going to go with a non-oral form.

因此，出于这个原因，我倾向于使用非口服制剂来避免这种风险，特别是如果她有任何凝血家族史或个人凝血史，我们将采用非口服制剂。

Andrew Huberman:

安德鲁·休伯曼：

So these are things like elevations in factor five, Leiden,

这些是诸如五因子海拔高度之类的东西，莱顿，

Mary Claire Haver:

玛丽·克莱尔·哈弗：

M-T-H-F-R.

M-T-H-F-R。

If she's had a history of a blood clot, we are not going with an oral estrogen formulation.

如果她有血栓病史，我们不会采用口服雌激素制剂。

Andrew Huberman:

安德鲁·休伯曼：

And for people that haven't had a history of a blood clot, my understanding, which admittedly is very sparse, is that you can do a genetic test just by blood draw to see whether or not you have two normal copies of the gene for factor five leiden.

对于没有血栓病史的人来说，我的理解（诚然是非常稀疏的）是，您可以仅通过抽血进行基因测试，看看您是否有两个正常的莱顿因子五基因拷贝。

Some people are heterozygotes, so they're more at risk of presumably bleeding in that case.

有些人是杂合子，因此在这种情况下他们出血的风险更大。

But in other words, can people go into this knowing whether or not there are more or less at risk from taking estrogen

但换句话来说，人们是否可以了解服用雌激素是否存在或多或少的风险？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Hor therapy?

荷尔疗法？

So I don't think that there's a high enough for that reason because we're not routinely screening for these things unless they have a family history.

所以我认为这个原因还不够高，因为我们不会定期筛查这些东西，除非它们有家族史。

I'm going with non-oral estrogen as a primary product for my patients.

我将使用非口服雌激素作为我的患者的主要产品。

I can just skip that worry.

我可以跳过这个担心。

Andrew Huberman:

安德鲁·休伯曼：

So a patch typically,

所以补丁通常是

Mary Claire Haver:

玛丽·克莱尔·哈弗：

So typically transdermal, so a patch, there's even mist spray, there's FDA approved options of a patch.

通常是透皮给药，所以有贴剂，甚至还有喷雾剂，有 FDA 批准的贴剂选项。

There's gels, there's a spray, and there's a vaginal ring, which I love, love, love, because you put it in for three months and it treats, you get a two for one, you get a local treatment in the vagina as well as a systemic treatment as well.

有凝胶，有喷雾剂，还有阴道环，我非常喜欢，非常喜欢，因为你把它放进去三个月，它就可以治疗，你可以得到二合一的治疗，你可以得到阴道的局部治疗以及全身治疗。

It's just really expensive and typically not covered by insurance on the first tier.

它真的很贵，而且通常不在第一级保险的承保范围内。

So very few of my patients can afford it.

所以我的病人中很少有人能负担得起。

There are some injectables which no one in the Meno Posse uses the

有一些注射剂在美诺队中没有人使用

Andrew Huberman:

安德鲁·休伯曼：

Meno Posse.

梅诺队。

Yeah,

是的，

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Great.

太棒了。

There are

有

Andrew Huberman:

安德鲁·休伯曼：

Also, you've mentioned for me, the Metaverse and the Meno posse.

另外，你还为我提到了虚拟宇宙和美诺帮。

Are those terms that you coined?

这些术语是你创造的吗？

I love it.

我喜欢它。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

I think I did.

我想我做到了。

Yeah.

是的。

Great.

伟大的。

Andrew Huberman:

安德鲁·休伯曼：

All right.

好吧。

You heard it here.

你在这里听到了。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

So the Meno Posse is a group of healthcare professionals who are from multiple specialties.

因此，Meno Posse 是一群来自多个专业的医疗保健专业人员。

We have cardiologists, orthopedic surgeon, internal medicine.

我们有心脏病专家、骨科医生、内科医生。

Dr. Lyon is a member, and we have a big group chat and we all support each other.

Lyon博士是会员，我们有一个大群聊天，我们都互相支持。

We support each other's books and research, and we send articles back and forth and we support each other on social, but we also band it together to kind of negate one of the bigger publications on menopause than when the Lancet published.

我们支持彼此的书籍和研究，我们来回发送文章，我们在社交上互相支持，但我们也将其联合起来，以某种程度否定了比《柳叶刀》出版时更大规模的更年期出版物之一。

It's a whole nother discussion, but we are fighting for equity in menopause care and women's health.

这是一个完全不同的讨论，但我们正在为更年期护理和女性健康的公平而奋斗。

Andrew Huberman:

安德鲁·休伯曼：

Great.

太棒了。

Nothing succeeds like a group.

没有什么比团队更能成功。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

It's like the old menopause versus the new menopause.

这就像旧更年期与新更年期的对比。

I

我

Andrew Huberman:

安德鲁·休伯曼：

Love it.

喜欢它。

I love it.

我喜欢它。

So hormone therapy to increase estrogen.

所以激素治疗要增加雌激素。

How does it make women feel psychologically, physically?

它如何让女性在心理上、身体上感受到什么？

What are some of the positive changes that can occur aside from just offsetting some of the negative?

除了抵消一些负面影响之外，还可能发生哪些积极变化？

And I want to make sure that I remember to ask what if a woman has been in menopause for has passed that point?

我想确保我记得问一下，如果女性已经进入更年期，已经过了那个阶段怎么办？

Because as you said, it's a day.

因为正如你所说，这是一天。

So they passed that point a year earlier, two years earlier, three years earlier.

所以他们提前一年、两年、三年就通过了这一点。

Given the results of this first study, which as you explained it, are problematic and their interpretation, the way it was interpreted as opposed

鉴于第一项研究的结果（正如您所解释的那样）及其解释存在问题，其解释方式与

Mary Claire Haver:

玛丽·克莱尔·哈弗：

To initially, yeah.

最初，是的。

Andrew Huberman:

安德鲁·休伯曼：

Yep.

是的。

What's too long?

什么太长了？

Should women

女性应该

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Start long?

开始长吗？

Should you stay on

你是否应该继续留在

Andrew Huberman:

安德鲁·休伯曼：

Therapy in their forties just to smooth the transition?

四十几岁接受治疗只是为了平稳过渡？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Maybe we need more studies in this area.

也许我们需要在这个领域进行更多的研究。

Should we just the minute we figure out, I would love, I wear a glucose monitor.

如果我们一发现，我会喜欢，我戴上血糖监测仪。

I have insulin resistance.

我有胰岛素抵抗。

So for those

所以对于那些

Andrew Huberman:

安德鲁·休伯曼：

Listening, it looks like a little button sized

听着，它看起来像一个小按钮大小

Mary Claire Haver:

玛丽·克莱尔·哈弗：

On my arm sticker

我手臂上的贴纸

Andrew Huberman:

安德鲁·休伯曼：

On the back of the arm.

在手臂的背面。

I would

我会

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Love to develop one to track estrogen levels, starting your thirties, just see where you're at, start seeing are you having aberrations in your cycle?

喜欢开发一种跟踪雌激素水平的方法，从三十多岁开始，看看你处于什么位置，开始看看你的周期是否出现异常？

And we can start the perimenopause journey and talking about should we begin supporting.

我们可以开始围绝经期之旅并讨论我们是否应该开始支持。

I think there's a tremendous amount opportunity for research in this area.

我认为这个领域有大量的研究机会。

But typically we are not starting patients until they're very symptomatic.

但通常情况下，我们不会在患者出现严重症状之前开始治疗。

If they're perimenopausal or they're postmenopausal in general.

如果她们是围绝经期或一般绝经后。

Andrew Huberman:

安德鲁·休伯曼：

So if a woman is in her, let's say late thirties, she is anticipating perimenopause or maybe is in perimenopause and wants to start low dose hormone replacement therapy.

因此，如果一位女性已经三十多岁了，她即将进入围绝经期，或者可能正处于围绝经期，并且想要开始低剂量激素替代疗法。

I think it's something worth mentioning that presumably the dosages are tailored and then blood.

我认为值得一提的是，大概剂量是定制的，然后是血液。

So given dose is tried, blood is drawn, you measure estradiol.

因此，尝试给予剂量，抽血，测量雌二醇。

So

所以

Mary Claire Haver:

玛丽·克莱尔·哈弗：

We don't have established levels of therapeutic ranges of estradiol.

我们尚未确定雌二醇的治疗范围水平。

What we found is that when we do that so far, I think we have some opportunity here.

我们发现，到目前为止，当我们这样做时，我认为我们在这里有一些机会。

If on my level's 50 and your level's 50, I could feel like I'm on top of the world, my symptoms are gone, you still need more.

如果我的等级是 50，你的等级是 50，我会感觉自己处于世界之巅，我的症状消失了，你还需要更多。

So we are titrating from symptoms.

所以我们正在根据症状进行滴定。

Andrew Huberman:

安德鲁·休伯曼：

I see.

我明白了。

Yeah.

是的。

Interesting.

有趣的。

It's similar to what is done, similar-ish with testosterone replacement therapy, which these days, I sort half joke that you can change out the R in testosterone replacement because a lot of men are taking testosterone not as a replacement, meaning their levels are not lower than 300 grams per deciliter, which is kind of lower range.

这与睾酮替代疗法的做法类似，类似，这些天，我半开玩笑地说，你可以改变睾酮替代中的R，因为很多男性服用睾酮不是替代品，这意味着他们的水平不低于300克每分升，这是一个较低的范围。

They're sort of low middle and they're trying to get higher range.

他们的音域属于中低音域，他们正在努力达到更高的音域。

But hormone replacement therapy, as I understand it, has never been strictly in men or women strictly for people who are out of range, that in theory it can be to optimize reduce symptoms and to optimize wellbeing.

但据我了解，激素替代疗法从未严格针对男性或女性，严格针对超出范围的人，理论上它可以优化减轻症状并优化健康。

And I don't know if the medical establishment wants it used that way, but certainly in the case of testosterone replacement therapy in men, it's being used that way quite often, in fact.

我不知道医疗机构是否希望以这种方式使用它，但事实上，在男性睾酮替代疗法的情况下，它经常被这样使用。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

So we don't have established therapeutic ranges for estradiol.

所以我们还没有确定雌二醇的治疗范围。

If she's POI, premature ovarian insufficiency, we know we want to get her to a hundred or around a hundred or higher in picograms per deciliter.

如果她患有 POI（卵巢早衰），我们知道我们希望她的每分升浓度达到 100 或大约 100 或更高。

But in the menopausal patient, we are rarely checking levels.

但对于更年期患者，我们很少检查其水平。

But I do think we have an opportunity to learn a lot more now that we're able to track how does it affecting your cholesterol.

但我确实认为我们现在有机会了解更多，因为我们能够追踪它如何影响您的胆固醇。

We need to look at those numbers.

我们需要看看这些数字。

What's the optimal dose for cholesterol?

胆固醇的最佳剂量是多少？

What's the optimal dose for cardiovascular disease?

心血管疾病的最佳剂量是多少？

All these studies have looked at, was she on it or not?

所有这些研究都考察了她是否参与其中？

So that's where I think the opportunities can come.

所以我认为这就是机会的所在。

Andrew Huberman:

安德鲁·休伯曼：

So if a woman goes on hormone replacement therapy, how often is she coming in for blood draws or are you just Well,

因此，如果一名女性接受激素替代疗法，她多久抽一次血，或者您是否健康，

Mary Claire Haver:

玛丽·克莱尔·哈弗：

It depends.

这取决于。

Testosterone, we tend to check more often.

睾酮，我们倾向于更频繁地检查。

We don't have an FDA approved option for women for testosterone.

我们没有 FDA 批准的女性睾酮选择。

So no, we either try to get her T stem or she's finding someone to insert a pellet or something.

所以不，我们要么试图得到她的 T 形茎，要么她找人插入颗粒或其他东西。

And there's other issues with that.

还有其他问题。

What I do in Texas is really hard.

我在德克萨斯州所做的事情真的很难。

The pharmacists do not like to do the T stem for patients.

药剂师不喜欢给病人做T型茎。

And I've even T stem.

我什至有T 茎。

T stem is the gel and I end up compounding it in a cream and do a transdermal cream for the patients.

T 茎是凝胶，我最终将其混合在霜中，为患者制作透皮霜。

But there's such variable absorption, we do tend to check more levels of that just to try to get her therapeutic.

但吸收的变化如此之大，我们确实倾向于检查更多的水平，只是为了让她得到治疗。

So what for women at peak dose is somewhere in a healthy female, 35 to 70.

那么对于女性来说，峰值剂量是在健康女性（35 岁到 70 岁）的某个地方。

And so I had a woman coming in with signs of hyperandrogenism.

因此，我接待了一位有雄激素过多症迹象的女士。

She's deep voice, hair growth, whatever, acne.

她的声音低沉，头发生长，无论如何，还有痤疮。

And I'm going to check a level if it's above 90 for females, I need to look for a tumor that's too high or PCOS.

我要检查女性的水平是否高于 90，我需要寻找是否存在过高的肿瘤或 PCOS。

It can get that high, certainly above 200.

它可以达到那么高，肯定超过200。

That's outrageous.

这太离谱了。

So I'm trying to get my patients 60, 50, 70, but if she's like 50 and she's got her libido back and she feels great and everything's wonderful, then I'm hold because the higher we go, the more likely you are to have side effects.

所以我试图让我的病人达到 60、50、70，但如果她大约 50 岁，她的性欲恢复了，她感觉很好，一切都很棒，那么我会坚持下去，因为我们走得越高，就越有可能出现副作用。

So you're losing temporal hair loss, voice deepening acne, new chin hair, losing hair where you want it, gaining hair where you don't want it, is how I explain it to patients.

因此，你会出现颞部脱发、声音加深的痤疮、新的下巴毛发、想要脱发的地方脱发、不想要脱发的地方长出头发，这就是我向患者解释的方式。

Andrew Huberman:

安德鲁·休伯曼：

And so when you say 50, that's 50 nanograms per deciliter.

因此，当您说 50 时，即为每分升 50 纳克。

I think many people, including myself, were surprised to learn that women actually have higher levels of testosterone than they do estrogen outside of in

我想很多人，包括我自己，都惊讶地发现女性体内的睾酮水平实际上比体内的雌激素水平还要高。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Absolute ranges,

绝对范围，

Andrew Huberman:

安德鲁·休伯曼：

Right?

对吗？

In absolute ranges.

在绝对范围内。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

And I can tell you right now, your natural level of estradiol is higher than mine.

我现在可以告诉你，你的雌二醇自然水平比我高。

Now I've supplement, but when I go through menopause, your residual estradiol is now higher than a postmenopausal woman.

现在我补充了，但是当我经历更年期时，你的残留雌二醇现在比绝经后的女性还高。

Andrew Huberman:

安德鲁·休伯曼：

So this is the estradiol that I have because testosterone was aromatized into estrogen.

这就是我所拥有的雌二醇，因为睾酮被芳香化为雌激素。

Yeah, interesting.

是的，有趣。

Interesting.

有趣的。

So much is breaking down around the old stereotypes of test

旧的测试刻板印象正在被打破

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Testosterone men the hormones and female testosterone is a human hormone, estrogen is a human hormone,

睾酮是男性荷尔蒙，女性荷尔蒙 睾酮是人体荷尔蒙，雌性荷尔蒙是人体荷尔蒙，

Andrew Huberman:

安德鲁·休伯曼：

And they exist in both biological sexists.

它们同时存在于生物性别歧视者中。

Yeah.

是的。

It's sometimes unfortunate that compounds in the body get names like steroid hormones because then people hear steroids and then it has a gravitational pull toward anabolic steroid use or even the word fat.

有时不幸的是，体内的化合物被命名为类固醇激素，因为人们一听到类固醇，就会倾向于使用合成代谢类固醇，甚至是“脂肪”这个词。

It's like dietary fat versus subcutaneous fat versus visceral

这就像膳食脂肪与皮下脂肪与内脏脂肪的比较

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Fat.

脂肪。

Yeah, visceral have this negative

是的，本能有这种消极

Andrew Huberman:

安德鲁·休伯曼：

Connotation.

内涵。

We mean better nomenclature to avoid a lot of the confusion that exists out there.

我们的意思是更好的命名法，以避免存在的许多混乱。

What are some of the other hormones that can be reduced and can possibly be replaced by hormone therapy progestins?

还有哪些其他激素可以减少并可能被激素治疗孕激素替代？

Is there a role for adjusting things like prolactin or is there a role for other hormones in that?

是否有调节催乳素等激素的作用，或者是否有其他激素的作用？

What sure is to be a multifactorial thing?

什么肯定是一个多因素的事情？

I mean, I think menopause is a process, not an event

我的意思是，我认为更年期是一个过程，而不是一个事件

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Hypogonadism for females.

女性性腺功能减退症。

And so we know that because the pituitary hypothalamus are involved and that GNRH, there's some cross reactivity.

所以我们知道，由于垂体下丘脑和 GNRH 都参与其中，所以存在一些交叉反应。

So for example, hypothyroidism, when I have a patient who's and doing well on hormone therapy for her thyroid, so she's on T three, T four, whatever she's on, I'm like, listen, we need to recheck your thyroid levels in six weeks because giving you back estrogen is going to mess with a little bit of that feedback cycle.

举个例子，甲状腺功能减退症，当我有一个病人，她的甲状腺激素治疗效果很好，所以她服用 T 3、T 4，无论她服用什么，我想，听着，我们需要在六周内重新检查你的甲状腺水平，因为给你雌激素会扰乱这个反馈周期。

So we need to make sure you're still therapeutic.

所以我们需要确保你仍然处于治疗状态。

So I think we've got more work to do with some of the other hormones, but when we talk about replacement in menopause, we are mostly looking at your estrogens, your androgens and your progesterone, so the formulations can differ.

所以我认为我们在其他一些激素方面还有更多的工作要做，但是当我们谈论更年期的替代激素时，我们主要关注的是雌激素、雄激素和孕激素，因此配方可能会有所不同。

And there's a lot of misunderstanding around what is bioidentical versus synthetic.

关于什么是生物同质性与合成性，存在很多误解。

And I think a lot of cottage industries in this little bubble that we had for 23 years where doctors were afraid to prescribe hormone therapy and then women were desperate for care.

我认为这个小泡沫中有很多家庭手工业，我们已经存在了 23 年，医生不敢开激素治疗，而女性则迫切需要护理。

We had some little cottage industries of people I think we're in trying to help, but kind of developed terminology that really isn't medically specific like estrogen dominance and what that really is.

我们有一些小型家庭手工业，我认为我们正在努力提供帮助，但是一些成熟的术语实际上并不像雌激素优势及其真正含义那样具有医学特定性。

And so that is not a term that isn't any medical journal.

所以这不是一个不属于任何医学期刊的术语。

It's kind of something coined, I think from a well-meaning provider trying to explain what's happening in perimenopause, that you're having more estrogen produced than progesterone than you used to have.

我认为这是一个善意的提供者创造的东西，试图解释围绝经期发生的事情，你产生的雌激素比孕激素比以前更多。

So PCO patients do the same thing.

所以 PCO 患者也会做同样的事情。

There's multiple reasons for that to happen.

发生这种情况的原因有多种。

So when we talk about in the metaverse of what we we're trying to replace, we all agree that we stick pretty much with estradiol.

因此，当我们在虚拟世界中谈论我们试图取代的东西时，我们都同意我们几乎坚持使用雌二醇。

We're just trying to give you back the water you were drinking.

我们只是想把你喝过的水还给你。

So I want to get as close to what your body used to make because that's what the receptor's like.

所以我想尽可能接近你的身体过去产生的东西，因为这就是受体的样子。

I'm trying to give you progesterone rather than a synthetic.

我正在尝试给你黄体酮而不是合成物。

Not that they're all demonized.

并不是说他们都被妖魔化了。

Progesterone doesn't work for everyone.

黄体酮并不适合所有人。

I'm glad I have options.

我很高兴我有选择。

And then for your androgens, we pretty much just do testosterone and we do a transdermal again because the oral can be hepatotoxic unless it's EC and oh eight, which isn't available in the us, but there's no F FDA a approved option for women.

然后对于雄激素，我们几乎只做睾酮，然后再次进行透皮注射，因为口服可能具有肝毒性，除非是 EC 和哦八，这在美国不可用，但 F FDA 没有批准女性的选择。

So it's not covered by insurance.

所以不在保险范围之内。

We know it works for hypoactive sexual desire disorder.

我们知道它对性欲减退症有效。

What your followers we call libido.

你的追随者我们称之为性欲。

We think we know testosterone does.

我们认为我们知道睾酮的作用。

Yeah.

是的。

Women at the highest quartile of testosterone have better bone density and stronger muscles.

睾丸激素水平最高四分之一的女性具有更好的骨密度和更强的肌肉。

So I'm using it off label for my patients who come in with osteoporosis, osteopenia or sarcopenia, I'm using it off label telling them this is probably, it's not a hail Mary.

因此，我对患有骨质疏松症、骨质减少症或肌肉减少症的患者使用非适应症药物，我用非适应症药物告诉他们这可能是，这不是冰雹玛丽。

We think it works, but we don't have, it's not approved for that yet.

我们认为它有效，但我们没有，它尚未获得批准。

We know it has receptors in the brain.

我们知道它在大脑中有受体。

My patients are saying that they're more clarity of thought, they're sleeping better.

我的病人说他们的思路更加清晰，睡眠也更好了。

They really, really like the testosterone.

他们真的非常喜欢睾酮。

So DHEA is a great vaginal preparation for DHEA called intrarosa, and then the receptors there will start converting it into both testosterone and estradiol through the process.

因此，DHEA 是一种很好的 DHEA 阴道制剂，称为“intrarosa”，然后那里的受体将开始通过该过程将其转化为睾酮和雌二醇。

And so the sexual medicine docs really like intrarosa, especially for breast cancer patients because they get that little boost of testosterone in the vulva.

因此，性医学确实很喜欢intrarosa，特别是对于乳腺癌患者，因为他们的外阴睾酮水平微乎其微。

Intrarosa

因特拉罗萨

Andrew Huberman:

安德鲁·休伯曼：

Intrarosa

因特拉罗萨

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Is the brand name, I think it's

是品牌名称吗，我认为是

Andrew Huberman:

安德鲁·休伯曼：

Prasterone.

普拉斯特酮。

And this is a prescription drug.

这是处方药。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

These are prescriptions,

这些是处方，

Andrew Huberman:

安德鲁·休伯曼：

So intra Rosa's prescription, DHEA, which sits

所以罗莎的处方 DHEA 就在其中

Mary Claire Haver:

玛丽·克莱尔·哈弗：

For specifically formulated for the vagina.

专为阴道配制。

Andrew Huberman:

安德鲁·休伯曼：

Got it.

明白了。

Which sits further upstream to the production of testosterone and estrogen.

它位于睾酮和雌激素产生的更上游。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

And so fortunately what's left in the vagina is able to plug that guy in and get it to produce both testosterone and estradiol, which testosterone is the immediate precursor.

幸运的是，阴道中剩下的东西能够将那个家伙插入并使其产生睾酮和雌二醇，而睾酮是直接前体。

We have to aromatize it right to make estradiol in females as well.

我们必须对其进行芳香化，才能在女性中产生雌二醇。

Andrew Huberman:

安德鲁·休伯曼：

These local effects on tissues are interesting.

这些对组织的局部影响很有趣。

They make perfect sense if the highest concentration is at the site of release from the patch or the gel or the whatever you said intravaginal, what is it?

如果最高浓度是在贴剂或凝胶或您所说的阴道内释放的部位，那么它们是完全有道理的，它是什么？

It's like a capsule.

它就像一个胶囊。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

I think the pone is a insert, like a little gel looking, not a gel, but I forget what the binding material is, but it's like a little insert you put in and

我认为电话是一个插入物，就像一个小凝胶看起来，不是凝胶，但我忘记了粘合材料是什么，但它就像你放入的一个小插入物

Andrew Huberman:

安德鲁·休伯曼：

It melts.

它融化了。

Okay.

好的。

So the local effects, because I guess it stands to reason that the highest concentrations can be at the site of the thing that's releasing the hormone, but then it also goes systemic by getting into the bloodstream

所以局部效应，因为我想按理说，最高浓度可能出现在释放激素的部位，但随后它也会通过进入血液而进入全身

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Actually.

事实上。

So the local formulations, the pone and the osa, and as well as the estradiol formulated for the vagina do not absorb systemically.

因此，局部制剂、pone 和 osa 以及为阴道配制的雌二醇不会被全身吸收。

They're so low dose.

它们的剂量是如此之低。

There has not been clinically significant tissue absorption.

尚未出现具有临床意义的组织吸收。

I have a formulation for my face as well.

我也有适合我脸的配方。

So

所以

Andrew Huberman:

安德鲁·休伯曼：

It's

这是

Mary Claire Haver:

玛丽·克莱尔·哈弗：

A cream cream that I put on my face.

我涂在脸上的奶油霜。

And so there's some decent studies with ESTRO L, but we lose 30% of our collagen.

因此，有一些关于 ESTRO L 的不错的研究，但我们失去了 30% 的胶原蛋白。

It's a very big pain point for women when they go through menopause that we lose so much collagen so quickly in the first five years of menopause.

对于女性来说，当她们经历更年期时，这是一个非常大的痛点，因为我们在更年期的前五年里，胶原蛋白流失得如此之快。

And so we can slow that process down.

所以我们可以放慢这个过程。

We can't stop it completely.

我们无法完全阻止它。

We can slow it down by using a topical estrogen.

我们可以通过使用局部雌激素来减慢它的速度。

And the topical really seems to help with the elastin concentrations as well.

局部用药似乎也确实有助于提高弹性蛋白的浓度。

Andrew Huberman:

安德鲁·休伯曼：

Interesting.

有趣。

So you will often prescribe a lot of local treatments for

所以你经常会开很多局部治疗方法

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Hormone hormone replacement.

激素替代激素。

Yes.

是的。

Really, it's so safe.

真的，太安全了。

So we can take breast cancer off the table.

这样我们就可以消除乳腺癌。

All the discussion around blood clots and everything, everyone can use vaginal estrogen and they should.

所有关于血栓和一切的讨论，每个人都可以使用阴道雌激素，他们应该这样做。

And I'll tell you why.

我会告诉你原因。

Andrew Huberman:

安德鲁·休伯曼：

Starting at what age relative to

从什么年龄开始

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Menopause, the old menopause thoughts is do not give vaginal estrogen until she's symptomatic.

更年期，旧的更年期想法是在出现症状之前不要给予阴道雌激素。

Now all of us will become symptomatic from GSM, so that's genital urinary syndrome of menopause.

现在我们所有人都会出现 GSM 的症状，这就是更年期生殖泌尿综合症。

So from the pubic bone all the way to the sacrum, all of that tissue is heavily tied to estrogen testosterone.

因此，从耻骨一直到骶骨，所有这些组织都与雌激素睾酮密切相关。

And when those levels decline, we see thinning of the tissue, loss of elasticity, loss of mucus production, as well as the health of the urethra.

当这些水平下降时，我们会看到组织变薄、弹性丧失、粘液分泌减少以及尿道健康状况恶化。

And so UTIs, the best treatment for recurrent UTIs in a menopausal patient is vaginal estrogen.

因此，对于绝经期患者复发性尿路感染的最佳治疗方法是阴道雌激素。

Interesting.

有趣的。

Not recurrent antibiotics.

不需反复使用抗生素。

Andrew Huberman:

安德鲁·休伯曼：

And what about,

那又怎样呢，

Mary Claire Haver:

玛丽·克莱尔·哈弗：

So it's preventative.

所以这是预防性的。

Very interesting.

非常有趣。

And we can probably keep 50% of women out of the ER and out of sepsis if we gave them all prophylactic vaginal estrogen.

如果我们给 50% 的女性提供预防性阴道雌激素，我们可能可以让 50% 的女性远离急诊室并避免败血症。

All these ladies in nursing homes should be on vaginal estrogen.

所有这些住在疗养院的女士都应该服用阴道雌激素。

So just to protect them from getting U sepsis.

所以只是为了保护他们免于感染脓毒症。

Andrew Huberman:

安德鲁·休伯曼：

Interesting.

有趣。

What about urinary incontinence and some of these other symptoms that are associated with more elasticity, presumably more elasticity of tissue in that region if

尿失禁和其他一些与弹性更大的症状有关，大概是该区域组织的弹性更大，如果

Mary Claire Haver:

玛丽·克莱尔·哈弗：

You're early in a, so we have stress incontinence and then we have overactive bladder urgent incontinence.

你还处于早期阶段，所以我们有压力性尿失禁，然后我们有膀胱过度活动症紧急尿失禁。

And so it definitely helps with urgent incontinence.

因此，它绝对有助于治疗紧急尿失禁。

It helps to relax and decrease the inflammation in the wall of the bladder.

它有助于放松并减少膀胱壁的炎症。

So thumbs up there.

所以竖起大拇指。

So people are getting up at night and having that urge to go, but stress incontinence is an anatomical problem.

因此，人们在晚上起床时就有想走的冲动，但压力性尿失禁是一个解剖学问题。

We've lost the sling that holds up the urethra and the female fails right from herniation and poor tissue health.

我们失去了支撑尿道的吊带，女性因疝气和组织健康状况不佳而失败。

We can build up that health and there's physical therapy.

我们可以通过物理治疗来增强健康。

There's lots of options.

有很多选择。

And know urogynecologist wants to take a woman to or do a lift.

并且知道泌尿妇科医生想要带女性去或搭便车。

If she's not estrogenized, they're all going to get vaginal estrogen pre through healing and then forever to keep the tissue healthy.

如果她没有雌激素化，他们都会在愈合前获得阴道雌激素，然后永远保持组织健康。

Andrew Huberman:

安德鲁·休伯曼：

Everything that we've been talking about for about the last 15 or 20 minutes seems to go directly opposite this large scale study that was discussed at the Watergate Hotel.

过去 15 或 20 分钟我们所谈论的一切似乎都与水门酒店讨论的这项大规模研究背道而驰。

Is your read that the medical establishment, in particular the OB GYNs in the US and in other countries, understand now that that study was flawed to some extent in its design or is what we're talking about here really cutting edge?

您是否读到，医疗机构，特别是美国和其他国家的妇产科医生，现在是否明白这项研究在设计上存在一定程度的缺陷，或者我们在这里谈论的内容真的很前沿？

I mean, if we were to gather a room full of a thousand OBGYNs,

我的意思是，如果我们要聚集一个充满一千名妇产科医生的房间，

Mary Claire Haver:

玛丽·克莱尔·哈弗：

I think 10 in

我认为10在

Andrew Huberman:

安德鲁·休伯曼：

Various decades put

不同的几十年

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Them there, maybe 10% would have any idea.

他们那里，也许有 10% 的人有任何想法。

But here's why, and I'm going to call out the American Board of OBGYN directly on this.

但这就是原因，我将就此直接向美国妇产科委员会提出申诉。

We take our board certification exams every year and our specialty as every specialty does, and they give us a set of articles of the cutting edge newest research, and it's divided into categories, obstetrics office practice, gynecology, GYN, surgery, pediatrics.

我们每年都会参加我们的委员会认证考试，我们的专业和每个专业一样，他们给我们一套最前沿的最新研究文章，它分为类别，产科诊所实践、妇科、妇科、外科、儿科。

There is no menopause category, nothing.

没有更年期类别，什么都没有。

So I went back over 10 years of all my green journals and looked at how many articles were anything to do with menopause and it was less than 1%.

所以我回顾了 10 多年来我所有的绿色期刊，看看有多少文章与更年期有关，结果不到 1%。

So they were not systematically trying to put the latest menopause information in front of us.

所以他们并没有系统地尝试将最新的更年期信息摆在我们面前。

They don't even recognize the menopause society as a entity.

他们甚至不承认更年期社会是一个实体。

Andrew Huberman:

安德鲁·休伯曼：

Well now they have to contend with the menopause.

现在他们必须应对更年期。

They do.

他们确实这么做了。

And

并且

Mary Claire Haver:

玛丽·克莱尔·哈弗：

You might see me banned from the abo, but you know

你可能会看到我被禁止参加 abo，但你知道

Andrew Huberman:

安德鲁·休伯曼：

What, no, no, no. But

什么，不，不，不。但是

Mary Claire Haver:

玛丽·克莱尔·哈弗：

I'm so proud of what I learned.

我对我所学到的感到非常自豪。

I learned amazing things.

我学到了惊人的东西。

I'm a boss at delivering a baby at taking care of a pregnant patient.

我是接生的老板，也是照顾怀孕病人的老板。

I am great at pediatric gynecology.

我擅长小儿妇科。

I was so good with adolescence where I failed and where I let the system let me fail was in the care of a woman after reproduction, outside of surgery, outside of her surgical needs.

我在青春期表现得很好，但我失败了，我让系统让我失败的地方是在生育后，在手术之外，在她的手术需求之外，由一个女人照顾。

Andrew Huberman:

安德鲁·休伯曼：

Well, I have to imagine that given the medical profession is interested in the wellbeing of people and in for sake of the discussion today, women, that they will be grateful that now you have a microphone, many microphones in various contexts.

好吧，我必须想象，鉴于医学界对人们的福祉感兴趣，并且为了今天的讨论，女性，她们会感激现在你有一个麦克风，在不同的情况下有很多麦克风。

So that is surprising to me.

所以这让我感到惊讶。

However, I would think that given the exciting findings around hormone replacement therapy and the, I'm kind of obvious at least when you describe them to me, obvious flaws in these earlier studies of starting hormone replacement therapy when women are already 61, when they've already accumulated in many cases some health issues, that it would be kind of obvious

然而，我认为，考虑到有关激素替代疗法的令人兴奋的发现，以及，至少当你向我描述它们时，我很明显，这些早期研究中在女性已经 61 岁时开始激素替代疗法的明显缺陷，当她们在许多情况下已经积累了一些健康问题时，这将是显而易见的

Mary Claire Haver:

玛丽·克莱尔·哈弗：

You missed the ability to measure the protective benefits.

您错过了衡量保护效益的能力。

But fortunately we've got great studies coming out of the Danish data, the Scandinavian that are really looking at this again and showing the protective benefits.

但幸运的是，我们从丹麦的数据中得到了很好的研究，斯堪的纳维亚人确实再次审视了这一点并显示了保护作用。

So

所以

Andrew Huberman:

安德鲁·休伯曼：

Is it generally the case that the studies out of Europe and Scandinavia are more forward thinking?

一般来说，欧洲和斯堪的纳维亚半岛的研究是否更具前瞻性？

It

它

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Depends.

视情况而定。

Some of the most forward thinking shockingly is come out of Asia, a lot out of China.

令人震惊的是，一些最具前瞻性的想法来自亚洲，其中很多来自中国。

And I asked my husband, he's worked there before and he said there's as many researchers in China that are female as male.

我问我丈夫，他以前在那里工作过，他说中国研究人员中女性和男性一样多。

It's not like they have a big stay at home culture.

他们并不是有很大的待在家里的文化。

They're not, women are expected to work and they're getting PhDs and they're doing the research and he thinks in his end of one, his humble opinion and he's an engineer, I was like, why do you think you've worked over there?

他们不是，女性应该工作，她们正在获得博士学位，她们正在做研究，他认为在他的最后，他的谦虚观点和他是一名工程师，我想，你为什么认为你在那里工作？

He goes, I think because there's just as many women who are writing the papers as men.

我想他之所以去是因为写论文的女性和男性一样多。

Andrew Huberman:

安德鲁·休伯曼：

Interesting take.

有趣的采取。

I like it.

我喜欢它。

It makes good sense.

这是有道理的。

What are the various things that people can do in terms of non-hormone replacement therapies that can support them through really into and through perimenopause and menopause?

在非激素替代疗法方面，人们可以做哪些事情来支持他们真正进入并度过围绝经期和更年期？

We talked about nutrition earlier.

我们之前讨论过营养。

Maybe we could touch on that a little bit more.

也许我们可以进一步讨论这一点。

We talked about behaviors, resistance training, maintaining maybe even increasing muscle mass.

我们讨论了行为、阻力训练、维持甚至增加肌肉质量。

There's no pressure to include them, but what about the various supplements that we hear about that can touch on or we are told can touch on these hormone pathways.

没有压力将它们包括在内，但是我们听说的各种补充剂可以触及或我们被告知可以触及这些激素途径。

Things like dim, things like grape seed extracts, things like

诸如暗淡之类的东西，诸如葡萄籽提取物之类的东西

Mary Claire Haver:

玛丽·克莱尔·哈弗：

I think the data

我认为数据

Andrew Huberman:

安德鲁·休伯曼：

Evening primrose,

月见草，

Mary Claire Haver:

玛丽·克莱尔·哈弗：

I don't think they're harmful, but there's just not robust data to really support.

我不认为它们有害，但没有可靠的数据来真正支持。

So menopause society went and looked at all of them, even soy and everything, and they just outside of cognitive behavioral therapy, which can be helpful but is not a menopause cure.

因此，更年期社会对所有这些都进行了研究，甚至包括大豆和所有东西，它们只是在认知行为疗法之外，这可能会有帮助，但不是更年期的治疗方法。

They didn't find much in the supplement world that would stop.

他们在补充剂世界中没有发现太多可以停止的东西。

Remember, we're defining menopause as hot flashes in general urinary syndrome of menopause.

请记住，我们将更年期定义为更年期一般泌尿综合症中的潮热。

So when I'm recommending supplements to patients, I do think there's some okay data on turmeric for maybe hot flashes, but I'm not saying to take that instead of replacing the estrogen in your body is missing greatly.

因此，当我向患者推荐补充剂时，我确实认为有一些关于姜黄可能治疗潮热的良好数据，但我并不是说用姜黄来代替体内严重缺失的雌激素。

I like the anti-inflammatory benefits of that supplement.

我喜欢这种补充剂的抗炎功效。

I'm recommending fiber, 80% of my patients are deficient in vitamin D and struggling to get it absorbed.

我推荐纤维，我的 80% 的患者缺乏维生素 D，并且难以吸收。

I'm recommending creatine for muscle.

我推荐肌酸来增强肌肉。

I'm recommending there's a specific bioactive collagen that was studied in menopausal women with osteoporosis where they saw improvement in bone density.

我建议在患有骨质疏松症的更年期女性中研究一种特定的生物活性胶原蛋白，她们发现骨密度有所改善。

So I'm recommending a weighted vest, great studies elderly women, but saw improvements in bone density.

所以我推荐一件加重背心，这对老年女性很有用，而且骨密度有所改善。

And I'm like, why do we wait until we're osteoporotic to make the diagnosis?

我想，为什么我们要等到骨质疏松症才做出诊断呢？

Andrew Huberman:

安德鲁·休伯曼：

Yeah, this is interesting.

是的，这很有趣。

So weighted vest,

如此加重的背心，

Mary Claire Haver:

玛丽·克莱尔·哈弗：

A weighted vest looked day long.

加重背心看起来一整天。

They looked at creatine, weighted vest vibratory training in nursing home dwelling.

他们研究了疗养院住宅中的肌酸、加重背心振动训练。

So there were kind of a population where they couldn't go anywhere.

所以有些人哪里都去不了。

Andrew Huberman:

安德鲁·休伯曼：

Vibratory training is the shake plate,

振动训练就是摇盘，

Mary Claire Haver:

玛丽·克莱尔·哈弗：

The shake plate.

摇盘。

And so anything that stimulates that musculoskeletal unit will send the signal to get stronger.

因此，任何刺激肌肉骨骼单位的东西都会发出变得更强的信号。

What most women don't realize, I mean they know about osteoporosis and they don't want to have it, but they don't understand that your habits in your thirties and forties are going to put you on that path and that your body's going to fight to lose muscle and bone naturally through the aging process and accelerated with menopause.

大多数女性没有意识到的是，我的意思是她们了解骨质疏松症，她们不想患上骨质疏松症，但她们不明白，你三四十岁的习惯会让你走上这条路，你的身体会在衰老过程中努力争取自然失去肌肉和骨骼，并随着更年期加速。

It doesn't have to be that way, but you have to do the work.

事情不必一定是这样，但你必须做这项工作。

And there's some hacks.

还有一些技巧。

And so I love the weighted vests for a hack.

所以我喜欢黑客用的加重背心。

I'm like, do the dishes with it on.

我想，就用它洗碗吧。

Go walk the dog.

去遛狗吧

How

如何

Andrew Huberman:

安德鲁·休伯曼：

Heavy

重型

Mary Claire Haver:

玛丽·克莱尔·哈弗：

In the nursing home they started at 10% of their body weight.

在疗养院里，他们从体重的 10% 开始。

So I'm like 10 pounds, 12 pounds, start with that.

所以我的体重大概是 10 磅、12 磅，从这个开始吧。

That's not So now my husband's obsessed and we have six of them and they go from eight to 35 pounds.

事实并非如此，所以现在我丈夫很着迷，我们有六个，它们的重量从 8 磅增加到 35 磅。

So I have different weights that I wear.

所以我穿的重量不同。

If I'm doing leg day, I'll put the heavier one on so I don't have to hold as heavy.

如果我要进行腿部训练，我会穿上较重的，这样我就不必握那么重的东西。

Andrew Huberman:

安德鲁·休伯曼：

So you'll use a weight vest when you're doing leg day.

因此，当您进行腿部训练时，您将使用举重背心。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Wow.

哇。

I don't have great grip strength.

我没有很强的握力。

And so it'll help me be able to squat heavier.

所以它会帮助我能够更重地深蹲。

But now I'm getting better it.

但现在我已经好多了。

I've got the bar going, so I'm getting there.

酒吧已经开动了，所以我要去那里了。

Andrew Huberman:

安德鲁·休伯曼：

I'm going to tell my sister and my mom this.

我要把这件事告诉我姐姐和妈妈。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Yeah, I've

是的，我已经

Andrew Huberman:

安德鲁·休伯曼：

Got my sister doing some resistance training.

让我姐姐做一些阻力训练。

It's been,

曾经是，

Mary Claire Haver:

玛丽·克莱尔·哈弗：

And it's just a cheat, so it's so cute on social, they'll post and tag me and they're walking their dog and they're doing whatever with their weighted vest on.

这只是一个作弊，所以它在社交上非常可爱，他们会发布并标记我，他们正在遛狗，他们穿着加重背心做任何事情。

And now in Galveston where I live, you see it all over the sea wall.

现在在我居住的加尔维斯顿，你可以在海堤上看到它。

Everyone's walking with their weighted vest on.

每个人都穿着加重背心走路。

Andrew Huberman:

安德鲁·休伯曼：

I love it.

我喜欢它。

And it's hot down there a lot of the year.

一年中很多时候那里都很热。

Yeah, it's warm.

是的，很温暖。

So no excuses.

所以没有任何借口。

People outside of Texas or in Texas for that matter.

德克萨斯州以外或德克萨斯州境内的人。

But my experience is that people in Texas don't tend to make excuses.

但我的经验是，德克萨斯州的人不喜欢找借口。

Anyway, that's said like a real Californian here.

无论如何，这就像一个真正的加州人所说的那样。

We were talking about this a little bit earlier and female specific weight vests.

我们之前讨论过女性特定重量背心。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

I would love to develop one because the ones were made for men and they're okay, but if you have larger breasts, it's hard where the snaps are to get it on.

我很想开发一款，因为这些是为男士设计的，而且还不错，但如果你的胸部较大，按扣在哪里就很难穿上。

And I know there's a big trend with wrecking, but that puts all the weight on your back.

我知道破坏是一种大趋势，但这会让你背上所有的负担。

And I really like the weighted vest.

我真的很喜欢加重背心。

I feel, and this is my opinion really, but that the reason why it's helping with your bone density is it's putting the weight on the entire axial skeleton rather than just the muscles on your back.

我觉得，这确实是我的观点，但它之所以有助于提高骨密度，是因为它将重量放在整个中轴骨骼上，而不仅仅是背部的肌肉上。

So we're putting the force more evenly supported, but some of my followers have written in and said they're struggling because they have larger breasts and how to get this around.

因此，我们正在更加均匀地支持力量，但我的一些追随者写信说，他们正在挣扎，因为他们的乳房更大，以及如何解决这个问题。

I'm like, I got to make one that's going to accommodate have longer to strap down here underneath the breast.

我想，我必须制作一个能够容纳更长的长度的绑带，绑在乳房下方。

Yeah,

是的，

Andrew Huberman:

安德鲁·休伯曼：

Someone should develop that.

应该有人开发它。

You should develop that.

你应该发展这一点。

Not that you don't already have enough on your plate already along the topic.

这并不是说您对这个主题的了解还不够。

I like rucking.

我喜欢摔跤。

It is sort of backloaded by definition.

根据定义，它有点后载。

Some of the weight vests that are out there are evenly distributed in a way that makes 'em pretty comfortable.

市面上的一些负重背心分布均匀，非常舒适。

They're not all loaded up upfront like a special operator or something would wear.

它们并不像特殊操作员或会磨损的东西一样预先加载。

So positive effects of the weight vest would be increased bone density.

因此，负重背心的积极作用是增加骨密度。

You're doing more work, you are

你正在做更多的工作，你

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Burning a little more calories, but you're doing more work, you're getting stronger.

燃烧更多的卡路里，但你会做更多的工作，你会变得更强壮。

But I coach to it with my followers for this is part of my osteoporosis prevention pack.

但我和我的追随者一起指导它，因为这是我的骨质疏松症预防包的一部分。

Andrew Huberman:

安德鲁·休伯曼：

Love it.

喜欢它。

Are you willing to share a few other things that are in the prevention pack?

您愿意分享预防包中的其他一些内容吗？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Eating adequate protein, doing resistance training, wearing your weighted vest, creatine five grams a day where most of the studies were done in the women

吃足够的蛋白质，进行阻力训练，穿着加重背心，每天补充五克肌酸，其中大多数研究都是在女性中进行的

Andrew Huberman:

安德鲁·休伯曼：

Creatine.

肌酸。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Yeah.

是的。

And then that collagen, consider that collagen.

然后是胶原蛋白，考虑一下胶原蛋白。

Full disclosure.

全面披露。

I do sell that one.

我确实卖那个。

But really good investment.

但确实是很好的投资。

I think

我认为

Andrew Huberman:

安德鲁·休伯曼：

Maybe we could talk about collagen for a moment.

也许我们可以谈谈胶原蛋白。

It's a complete protein.

它是一种完整的蛋白质。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

No, no, no. It's missing one.

不，不，不。还缺一个呢

I think one or two amino acids.

我认为是一两个氨基酸。

So it's not a complete protein.

所以它不是完整的蛋白质。

It's better than none.

有总比没有好。

So I do include my collagen and my protein intake for the day.

所以我确实包括了当天的胶原蛋白和蛋白质摄入量。

I eat all animal-based protein pretty much.

我几乎吃所有动物性蛋白质。

So I figure I'm covered my bases to have 10% of it coming with just missing two amino acids or I think it's one valine.

所以我认为我已经覆盖了我的碱基，其中 10% 只缺少两种氨基酸，或者我认为它是一种缬氨酸。

I have to look it up.

我得查一下。

Andrew Huberman:

安德鲁·休伯曼：

And what are the specific effects of a quality collagen?

优质胶原蛋白有哪些具体功效？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

So there's a lot of controversy there.

所以这里面有很多争议。

I've seen the videos.

我看过这些视频。

It is broken down into its component amino acids through the digestion process.

它通过消化过程分解成其组成氨基酸。

But the first ones I looked at were totally for vanity.

但我最初看的完全是为了虚荣。

I was changing bathing.

我正在换衣服洗澡。

I was trying on bathing suits with my daughter who was a little girl at the time, and I was complaining about the appearance of my cellulite.

我和当时还是个小女孩的女儿一起试穿泳衣，我抱怨我的橘皮组织的出现。

Even thin people have cellulite and she's, oh mommy, it doesn't look that bad.

即使是瘦人也会有橘皮组织，她说，哦，妈妈，看起来没那么糟糕。

Scientist in me goes on PubMed and starts looking up articles on cellulite and how to decrease the appearance of it.

我体内的科学家继续在 PubMed 上查找有关橘皮组织以及如何减少橘皮组织出现的文章。

So I found these articles on something called rasol and it was a collagen made in Germany and they'd studied, actually done really high quality studies like laser measuring wrinkles and cellulite.

所以我发现了这些关于 rasol 的文章，这是一种德国制造的胶原蛋白，他们进行了研究，实际上做了真正高质量的研究，例如激光测量皱纹和脂肪团。

Andrew Huberman:

安德鲁·休伯曼：

Germans are precise

德国人做事很严谨

Mary Claire Haver:

玛丽·克莱尔·哈弗：

And it looked, they had positive outcomes.

看起来，他们取得了积极的成果。

I'm like, well, it won't hurt me.

我想，好吧，它不会伤害我。

So I ordered, I Googled, where do I find this aerosol collagen.

所以我订购了，我在谷歌上搜索，在哪里可以找到这种气溶胶胶原蛋白。

I find this company, I order it.

我找到这家公司，我就订购了。

And then one day I talked about it on the internet and the company called me and said, would you please let us know when you do that?

然后有一天，我在互联网上谈论了这件事，公司打电话给我说，当你这样做时，请让我们知道吗？

They sold out of their supply for like three months.

他们在三个月内就断货了。

So the same manufacturer of that particular rasol made this forta bone, did the studies five years doing bone density scans on these women.

因此，该特定拉索尔的同一制造商制造了这种福塔骨，并进行了五年研究，对这些女性进行骨密度扫描。

It was a small study, but they saw improvements.

这是一项小型研究，但他们看到了改进。

We know what happens to bone density if you do nothing, it goes down.

我们知道，如果不采取任何措施，骨密度就会下降。

These went up and I thought, okay, I want to do and I want to offer this to people, if not them, me, this is a high quality product I can.

这些上升了，我想，好吧，我想做，我想把这个提供给人们，如果不是他们，我，这是我可以提供的高质量产品。

And so that's part of what I offer to people or what I recommend.

这就是我向人们提供或推荐的内容的一部分。

You can get it anywhere other people sell it, not just me.

你可以在任何其他人卖的地方买到它，而不仅仅是我。

Andrew Huberman:

安德鲁·休伯曼：

Great.

太棒了。

So I'm perplexed, this isn't a challenge, but I'm perplexed how would a protein that's not a complete protein be beneficial for a body organ?

所以我很困惑，这不是一个挑战，但我很困惑，一种不完整的蛋白质如何对身体器官有益？

Like skin, whereas the complete proteins don't seem to do it on their own?

就像皮肤一样，而完整的蛋白质似乎不能自行发挥作用？

I dunno.

我不知道。

Nobody knows.

没有人知道。

Okay.

好的。

I dunno.

我不知道。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Interesting.

有趣。

Are they not studying the right thing?

难道他们没有研究正确的东西吗？

Are they're not really looking at it.

他们真的没有在看吗？

So I don't know.

所以我不知道。

Andrew Huberman:

安德鲁·休伯曼：

Great.

太棒了。

When I hear, I don't know, the scientists in me says great area for exploration.

当我听到，我不知道，我体内的科学家说这是一个值得探索的伟大领域。

We don't really believe, in fact, we don't believe that amino acids that are target tissue, right, are derived from a particular body part target that tissue.

事实上，我们并不真正相信，我们不相信作为目标组织的氨基酸是源自针对该组织的特定身体部位。

We've heard this argument before, Dr. Lane Norton and I have both gone on record publicly saying there is basically zero, not basically delete the, basically there is zero evidence that when you ingest heart, let's say you like eating liver or heart or skeletal muscle, that somehow the amino acids are selectively trafficked to the organ of the heart or the liver or the skeletal muscle.

我们以前听过这个论点，莱恩·诺顿博士和我都公开表示，当你摄入心脏时，假设你喜欢吃肝脏或心脏或骨骼肌，氨基酸以某种方式被选择性地输送到心脏或肝脏或骨骼肌的器官，基本上是零，而不是基本上删除，基本上是零。

There's no evidence of that whatsoever.

没有任何证据表明这一点。

Certainly not in humans.

当然不是在人类身上。

If there is evidence, I'm sure they'll let us know in the comment section on YouTube and let us know.

如果有证据，我相信他们会在 YouTube 的评论部分告诉我们，让我们知道。

But yeah, it is perplexing why collagen would have a selectively beneficial effect on

但是，是的，令人困惑的是为什么胶原蛋白会对人体产生选择性的有益影响

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Skin and they didn't study it versus a steak.

他们没有研究皮肤和牛排。

They just looked at bone density.

他们只是观察骨密度。

If they took this product every day for five years and what happened and they weren't having tremendous cardiometabolic disease, they weren't on bone building medications, they weren't on HRT.

如果他们每天服用这种产品五年，并且发生了什么事，并且他们没有患有严重的心脏代谢疾病，他们就没有服用骨骼构建药物，他们就没有服用激素替代疗法。

So they did a pretty clean.

所以他们做得很干净。

So there's not a huge study, but it was interesting and I thought, okay, I don't want to break if I break my hip.

所以没有一项大规模的研究，但它很有趣，我想，好吧，如果我摔断了臀部，我不想摔断。

Well 50% of women will have an osteoporotic fracture before they die.

50% 的女性在去世前会发生骨质疏松性骨折。

Andrew Huberman:

安德鲁·休伯曼：

50%.

50%。

50.

50.

What about men do we know?

我们对男人了解多少？

Just by way of comparison?

只是通过比较吗？

I

我

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Think it's 25.

想想都25了

Wow.

哇。

But don't quote me on that.

但不要引用我的话。

I need to look.

我需要看看。

That's okay.

没关系。

That one up.

那个上来了

It's about half.

大约是一半。

Okay.

好的。

Then hip fracture, if you break that hip over the age of 65, you have your one year mortality.

然后是髋部骨折，如果你在 65 岁以上髋部骨折，你就会有一年的死亡率。

With surgical repairs, 30%.

通过手术修复，30%。

If you're not healthy enough to have the repair, you can't afford to have it.

如果您的健康状况不足以进行修复，则您负担不起。

It's 79.

79 了。

Goodness.

善良。

So that's what we're trying to avoid is that and the tremendous, if you've seen the women who have tremendous osteoporosis in their spine and just how their lives are so hard and how much pain they live in every single day.

所以这就是我们试图避免的，如果你见过那些脊柱患有严重骨质疏松症的女性，以及她们的生活是多么艰难，她们每天都生活在多么痛苦中，那就是巨大的。

A lot of this is avoidable with aggressive, being aggressive and intentional about this and HRT can be a huge part of that as well.

很多事情都是可以通过积极进取来避免的，对此采取积极进取和有意识的态度，激素替代疗法也可能是其中的重要组成部分。

Andrew Huberman:

安德鲁·休伯曼：

What I'm about to ask is a little bit outside the box, but I feel fair asking, given that I'm not a clinician, but I have some background and certainly understanding of neurodegenerative conditions of the eye and vision.

我要问的问题有点超出框架，但考虑到我不是临床医生，我觉得这个问题很公平，但我对眼睛和视力的神经退行性疾病有一些背景和肯定的了解。

Have you ever observed in your patients that when they get on hormone replacement therapy for menopause, that things that are typically associated with aging, like diminished visual function hearing?

您是否曾在患者中观察到，当她们接受更年期激素替代疗法时，会出现通常与衰老相关的症状，例如视觉功能听力下降？

You mentioned tinnitus, also called tinnitus.

您提到了耳鸣，也称为耳鸣。

I understand, but tinnitus, I think

我明白，但我觉得耳鸣

Mary Claire Haver:

玛丽·克莱尔·哈弗：

I

我

Andrew Huberman:

安德鲁·休伯曼：

We'll do both.

我们都会做。

Tinnitus, tinnius,

耳鸣，耳鸣，

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Tomato tinnitus.

番茄耳鸣。

I was

我是

Andrew Huberman:

安德鲁·休伯曼：

Like, okay, we'll do both here.

就像，好吧，我们都在这里做。

That they report seeing better, hearing better and any kind of sensory improvement or offset of sensory loss.

他们报告说视力更好了，听力更好了，任何感觉都得到了改善或抵消了感觉丧失。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

So we know the data's clear on dry eye and how that can affect, but how it affects the optic nerve.

因此，我们清楚地知道干眼症的数据及其如何影响，但它如何影响视神经。

We know that estrogen is anti-inflammatory, so any kind of inflammatory condition in and around the eye does tend to get better, but we need probably more data in this area for hearing.

我们知道雌激素具有抗炎作用，因此眼睛内部和周围的任何炎症状况确实都会好转，但我们可能需要更多这方面的数据来了解听力。

Most of the research is around tinnitus and vertigo.

大多数研究都是围绕耳鸣和眩晕进行的。

So the rate of which the crystals break off in the ear accelerates in menopause and people on HRT have less vertigo, new vertigo than they would have had before.

因此，在更年期，晶体在耳朵中脱落的速度会加快，接受激素替代疗法的人的眩晕感会比以前减少，新的眩晕感会减少。

And I forget what the pathophysiology that I rot in the book, but I can't think of it right now what the physiology was behind why tinnitus increases in menopause, but it's due to the estrogen levels declining.

我忘记了书中提到的病理生理学是什么，但我现在想不起来更年期耳鸣增加背后的生理学是什么，但这是由于雌激素水平下降所致。

Andrew Huberman:

安德鲁·休伯曼：

You mentioned dry eye.

你提到了干眼症。

A lot of people might hear dry eye and think, oh no big deal.

很多人可能听到干眼症并想，哦，没什么大不了的。

But actually dry eye is one of the most frustrating things to have and it's I believe a many billions of dollars a year industry to find treatments for dry eye.

但实际上，干眼症是最令人沮丧的事情之一，我相信每年业界都会花费数十亿美元来寻找干眼症的治疗方法。

So does estrogen replacement therapy improve dry

那么雌激素替代疗法可以改善干燥吗？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Eye?

眼睛？

It does seem to, they have less incidents.

看来他们的事故确实少了。

Most of the studies are just retroactive and they're looking at the incidences of those things on women on HRT for other reasons are not, and they just see, especially frozen shoulders, the best data there I think.

大多数研究只是回顾性的，他们正在研究因其他原因而接受激素替代治疗的女性身上这些事情的发生率，但他们只是看到了我认为最好的数据，尤其是肩周炎。

And what they see is a decreased risk of occurrence.

他们看到的是发生的风险降低了。

And then if they do have it, they have a shorter duration and easier course easier to treat if they're on HRT.

如果他们确实患有这种疾病，那么如果他们接受激素替代治疗，他们的病程会更短，病程更容易治疗。

Andrew Huberman:

安德鲁·休伯曼：

Fantastic.

太棒了。

So what are some of the cases where a woman can't or shouldn't do hormone replacement therapy and here we're using hormone replacement therapy as kind of a proxy for estrogen?

那么，在哪些情况下，女性不能或不应该进行激素替代疗法，而我们在这里使用激素替代疗法作为雌激素的替代疗法呢？

Estrogen

雌激素

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Therapy?

治疗？

Yeah, so any hormone sensitive cancer a, one of the things a lot of women don't understand, if you have dysfunctional uterine bleeding that has not been evaluated, you should not start hormone therapy because we don't know if it's cancer.

是的，所以任何激素敏感的癌症，很多女性不明白的一件事是，如果您患有功能失调性子宫出血且未经评估，您不应该开始激素治疗，因为我们不知道它是否是癌症。

So if you're having really heavy, especially if they're heavy bleeding clots out of nowhere, something unusual about the volume or the frequency of your bleeding, you need to go see a gynecologist and get that evaluated before you start hormone therapy.

因此，如果您的出血量非常多，特别是突然出现大量出血块，出血量或出血频率出现异常，您需要在开始激素治疗之前去看妇科医生并进行评估。

It may not be anything cancerous or tumors, it might just be the hormone changes, but that needs to be evaluated if known.

它可能不是任何癌症或肿瘤，可能只是激素变化，但如果知道的话需要进行评估。

Breast cancer, no, if you're actively having a blood clot that you're being treated for, they're saying, let's hold off until that therapy is over.

乳腺癌，不，如果你正在接受治疗，如果你正在积极地出现血栓，他们会说，让我们推迟一下，直到治疗结束。

Even if you've had a hormone sensitive cancer, including breast cancer, depending on the stage, the type and it's a very nuanced conversation does not mean that you were automatically disqualified for hormone therapy after your treatment.

即使您患有激素敏感性癌症，包括乳腺癌，根据阶段、类型以及这是一个非常微妙的对话，并不意味着您在治疗后自动取消激素治疗的资格。

So that is one of the biggest misconceptions out there.

所以这是最大的误解之一。

If you have really severe liver disease, I'm not talking about mild fatty liver disease, lots of menopausal women have that and it does tend to get better with HRT.

如果您患有非常严重的肝病，我说的不是轻度脂肪肝，许多更年期女性都患有这种疾病，并且通过激素替代疗法（HRT）确实会好转。

If you have severe liver disease, that is where estrogen begins to be metabolized.

如果您患有严重的肝脏疾病，那就是雌激素开始代谢的地方。

And so you could have abnormal metabolism.

所以你的新陈代谢可能会异常。

You don't want that.

你不想要这样。

So that's going to keep you from being a candidate.

所以这会让你无法成为候选人。

Andrew Huberman:

安德鲁·休伯曼：

Why do you think we're seeing or at least hearing about, in my case, PCOS, polycystic ovarian syndrome so much more?

您认为为什么我们会看到或至少听到，就我而言，多囊卵巢综合征、多囊卵巢综合症如此之多？

Is it because people are aware?

是因为人们意识到了吗？

Is it because

是不是因为

Mary Claire Haver:

玛丽·克莱尔·哈弗：

I think two reasons.

我认为有两个原因。

One, the obesity epidemic had led to more PCOS.

第一，肥胖流行导致更多的多囊卵巢综合症。

That is a risk factor for insulin resistance is usually the main pathophysiologic cause behind PCOS and I'm A-P-C-O-S then PCOS sufferer.

这是胰岛素抵抗的危险因素，通常是 PCOS 背后的主要病理生理原因，我是 A-P-C-O-S，然后是 PCOS 患者。

So I had it my whole reproductive life, both my But

所以我的整个生育生涯都是如此，无论是我的但是

Andrew Huberman:

安德鲁·休伯曼：

You're not obese at all?

你根本不胖吗？

No,

不，

Mary Claire Haver:

玛丽·克莱尔·哈弗：

No. They missed it forever.

不，他们永远怀念它。

I was just stressed out medical student,

我只是压力很大的医学生

Andrew Huberman:

安德鲁·休伯曼：

Which can potentially cause PCOS

这可能会导致多囊卵巢综合症

Mary Claire Haver:

玛丽·克莱尔·哈弗：

With acne.

伴有痤疮。

Yeah, I mean you can have PCOS is a symptom of something biologically apparent.

是的，我的意思是，多囊卵巢综合症可能是生物学上明显的症状。

It turns out I'm insulin resistant, which is why even though I'm thin.

事实证明我有胰岛素抵抗，这就是为什么尽管我很瘦。

And so we've had higher increasing levels of obesity, which is a risk factor for that also.

因此，我们的肥胖率不断上升，这也是一个风险因素。

People are talking about it and writing books about it.

人们正在谈论它并写关于它的书。

Karen Tang just published, it's not hysteria.

唐凯伦刚刚发表，这不是歇斯底里。

It's not hysteria, and she's a gynecologic surgeon, does a lot of work around endometriosis.

这不是歇斯底里症，她是一名妇科医生，在子宫内膜异位症方面做了很多工作。

So she has huge chapters on PCOS and how to advocate for herself and all about the disease process so people understand.

因此，她用了很多章节来介绍多囊卵巢综合症以及如何为自己辩护以及所有有关疾病过程的内容，以便人们理解。

Andrew Huberman:

安德鲁·休伯曼：

Interesting.

有趣。

What are some of the primary treatments for PCOS?

多囊卵巢综合症的主要治疗方法有哪些？

Is it going to be blocking androgens?

它会阻断雄激素吗？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Yes, and so for me, in all my training, it was always put 'em on birth control because it will suppress ovulation and suppress the overproduction of androgens in their system.

是的，对我来说，在我所有的训练中，总是让他们进行节育，因为这会抑制排卵并抑制体内雄激素的过量产生。

So I was a very happy birth control patient.

所以我是一个非常快乐的节育患者。

I was thin for the obese patients, if we can help them lose weight, it does tend to, they start ovulating again.

对于我本来就瘦的肥胖患者来说，如果我们能帮助他们减肥，那确实往往会让他们重新开始排卵。

And so now with the new GLP ones, a lot of PCOS will probably resolve itself and they'll start ovulating again and go back to normal cycles.

因此，现在有了新的 GLP 药物，许多 PCOS 可能会自行解决，他们将再次开始排卵并恢复正常周期。

That's the pregnancies that are happening from GLP ones.

这就是 GLP 妊娠所发生的情况。

Andrew Huberman:

安德鲁·休伯曼：

I see.

我明白了。

So GLP one associated

所以 GLP 一项相关联

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Pregnancies, GLP one babies.

怀孕，GLP 一胎。

Yeah, GLP one babies.

是的，GLP 一号宝贝。

We saw a surge of that when all the patients, the obese patients were getting the gastric bypasses, then they get pregnant.

当所有患者，肥胖患者都接受胃绕道手术，然后他们怀孕时，我们看到了这种情况的激增。

And so we were advising them to not be pregnant until their weight was stable for a year after surgery because of the medical implications of nutrition and pregnancy.

因此，由于营养和怀孕的医学影响，我们建议她们在手术后体重稳定一年之前不要怀孕。

But they were so excited and cute and now their libido's up and they're getting pregnant and never really needed contraception before and just assumed they'd still have trouble.

但他们是如此兴奋和可爱，现在他们的性欲增强了，他们正在怀孕，以前从未真正需要避孕，只是假设他们仍然有麻烦。

And so now they're ovulating and getting pregnant and we're seeing the same thing with GLP one.

现在她们正在排卵并怀孕，我们在 GLP 治疗中也看到了同样的情况。

So anyone listening out there who's prescribing a GLP one, please talk to your female patients about contraception if they don't want to be pregnant.

因此，任何在场聆听并开出 GLP 处方的人，如果不想怀孕，请与您的女性患者讨论避孕事宜。

Andrew Huberman:

安德鲁·休伯曼：

Very interesting and admittedly unforeseen implications of GLP one as long as we're there.

只要我们在那里，GLP 就会产生非常有趣且不可预见的影响。

What are your thoughts on ozempic manjaro?

您对 ozempic manjaro 有何看法？

I

我

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Think that they can be a really important tool for a lot of patients.

认为它们对于很多患者来说是一个非常重要的工具。

I don't think they're for everyone.

我不认为它们适合所有人。

I don't think people are being counseled adequately.

我认为人们没有得到充分的咨询。

A lot of them, I mean in my area outside of Galveston where I live, there are med spas giving out GOP ones and as far as I can tell, they're just giving them the meds and sending them out the door.

他们中的很多人，我的意思是在我居住的加尔维斯顿以外的地区，有医疗水疗中心发放共和党的药物，据我所知，他们只是给他们药物，然后把他们送出门外。

I've had patients coming in on it who were never counseled about the potential for muscle loss.

我有一些接受此疗法的患者，他们从未被告知肌肉损失的可能性。

So when I look at a patient's health, I look at a 30 year plan, and so they come in with a lifelong history usually of having a weight problem and a fat problem, and here's this medication that's going to take the food noise away and help them focus on the habits that are going to keep them healthy longer.

因此，当我查看患者的健康状况时，我会查看 30 年计划，因此他们终生都有体重问题和脂肪问题，而这种药物可以消除食物噪音，帮助他们专注于能够保持健康更长时间的习惯。

So I do have patients that I've prescribed it to.

所以我确实给一些病人开了药。

We have a very long discussion about adequate protein intake, resistance training.

我们对充足的蛋白质摄入、阻力训练进行了很长时间的讨论。

I have a way to measure their muscle mass.

我有办法测量他们的肌肉质量。

We are tracking that every month for them every month to six weeks while they're on the medication.

我们每个月都会跟踪他们在服药期间的每个月至六周的情况。

So women who are on HRT with the GLP one have a 30% increased weight loss.

因此，接受 HRT 和 GLP 治疗的女性体重减轻量增加了 30%。

Wow.

哇。

Andrew Huberman:

安德鲁·休伯曼：

Yeah.

是的。

Yeah, I appreciate that.

是的，我很欣赏这一点。

You mentioned that the use of ozempic majaro is not mutually exclusive with resistance training and improved nutrition.

您提到使用 ozempic majaro 与阻力训练和改善营养并不相互排斥。

No, I think the way it shows up on social media, it's sort of like people assume, well, you got to take great care of yourself and exercise.

不，我认为它在社交媒体上的表现方式，有点像人们认为，嗯，你必须好好照顾自己并锻炼身体。

Well, great, but there are also a number of people that are carrying excess weight to the point where they're at risk of injury when they exercise.

嗯，很好，但也有很多人体重超标，以至于在运动时有受伤的风险。

I mean, everyone's at risk of injury when they exercise, but what I'm hearing is that you basically take the view whatever can get people in a kind of forward center of mass around management of blood insulin levels, et cetera, because it wasn't that the original FDA approval was for, was it diabetes

我的意思是，每个人在锻炼时都有受伤的风险，但我听到的是，你基本上会采取任何可以让人们围绕血液胰岛素水平管理等向前重心的观点，因为 FDA 最初批准的目的不是糖尿病。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Type two diabetes

二型糖尿病

Andrew Huberman:

安德鲁·休伯曼：

Type two diabetes?

二型糖尿病？

And there's also some data as I recall, that ozempic manjaro can reduce alcohol cravings.

我记得还有一些数据表明，ozempic manjaro 可以减少对酒精的渴望。

Is that

是那个

Mary Claire Haver:

玛丽·克莱尔·哈弗：

So?

那么呢？

Yeah, the reward center in the brain or the noise.

是的，大脑中的奖励中心或噪音。

So they're looking now, I guess my friends who are obesity medicine specialists and are all reading every study that comes out, any kind of impulsive behavior or reward seeking behavior, gaming, gambling, alcohol, people are tending to do less of those behaviors because whatever's being blocked in the brain and more about this than I do seems to help with that, those drives.

所以他们现在正在寻找，我想我的朋友们都是肥胖医学专家，他们都在阅读每一项发表的研究，任何类型的冲动行为或寻求奖励的行为，游戏，赌博，酒精，人们往往会减少这些行为，因为任何在大脑中被阻塞的东西以及比我做的更多的事情似乎都有助于解决这些问题，这些驱动力。

Andrew Huberman:

安德鲁·休伯曼：

That's interesting that the hypothalamus is a Chaco block full of neurons associated with all sorts of drives and temperature regulation.

有趣的是，下丘脑是一个查科块，充满了与各种驱动和温度调节相关的神经元。

You mentioned earlier the preop area of the hypothalamus involved in temperature regulation, and we've always viewed those as somewhat separate, but they're actually quite interconnected, and so I'm not entirely surprised that a drug that would reduce cravings for food might also reduce cravings for other things.

您之前提到下丘脑的术前区域涉及温度调节，我们一直认为这些区域有些独立，但它们实际上是相互关联的，所以我并不完全惊讶于一种可以减少对食物的渴望的药物也可能减少对其他事物的渴望。

It's going to be really interesting to see what the science and the animal models and human shows us over time.

随着时间的推移，看看科学、动物模型和人类向我们展示的内容将会非常有趣。

Over time, it's

随着时间的推移，它

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Definitely

绝对

Andrew Huberman:

安德鲁·休伯曼：

Happening.

正在发生。

I mean, has it hit a trillion dollar industry yet?

我的意思是，它已经冲击了万亿美元的产业了吗？

It's probably hundreds of billions of

大概有几千亿

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Dollars.

美元。

I know that the majority of big research and funding is being funneled into this, maybe not all for the right reasons, but the obesity medicine specialists who who I turn to for how do I do this, how do we do it, how do I not hurt someone just to get them to lose weight and are very excited because these new levels, they say it's like the iPhone 12, the iPhone 13, they're just going to get better and better with lower side effects, better profiles as time goes on that we're going to look back at the manjaro and these earlier meds and be like, oh my God, what were we doing because of the side effects?

我知道大多数大型研究和资金都投入到了这个领域，也许并非都是出于正确的原因，但是我向肥胖医学专家求助，他们询问我该怎么做，我们该怎么做，我如何才能不伤害某人，只是为了让他们减肥，他们非常兴奋，因为这些新水平，他们说就像 iPhone 12、iPhone 13 一样，随着时间的推移，它们会变得越来越好，副作用越来越小，轮廓也越来越好，我们将回顾一下 Manjaro 和这些早期的药物，我会想，天哪，我们因为副作用而做了什么？

Andrew Huberman:

安德鲁·休伯曼：

Well, if nothing else, they're very interesting to pay attention to because it's clearly in the cultural zeitgeist right now.

好吧，如果不出意外的话，它们是非常值得关注的，因为它显然是现在的文化时代精神。

So every once in a while when a guest for whom the topic is of immense interest coming on the podcast, I'll put out a call on social media for questions.

因此，每隔一段时间，当一位对这个话题非常感兴趣的嘉宾出现在播客上时，我就会在社交媒体上打电话询问问题。

And so if you're willing, I'd like to just ask you a few of the audience questions and we can treat these as rapid fire or as much depth as you like.

因此，如果您愿意，我只想问您一些观众问题，我们可以将这些问题视为连珠炮，也可以根据您的喜好进行深度讨论。

First off, many of the questions you've already answered, things like what is the role for testosterone replacement therapy in women as opposed to just estrogen replacement therapy?

首先，您已经回答了许多问题，例如睾酮替代疗法相对于雌激素替代疗法对女性的作用是什么？

But one of the more common questions in here that we've touched on, but I think could deserve a bit more attention is if a woman is in her sixties and has already gone through menopause, is it appropriate for her to consider or at least just talk to her doctor about hormone replacement therapy or is she putting herself at risk?

但我们在这里提到的一个更常见的问题，但我认为值得更多关注的是，如果一位女性六十多岁并且已经经历了更年期，她是否适合考虑或至少与她的医生讨论激素替代疗法，或者她是否会将自己置于危险之中？

Mary Claire Haver:

玛丽·克莱尔·哈弗：

There's definitely worth the conversation.

绝对值得讨论。

So if I have a patient who comes in and she's more than 10 years past her menopause or over the age of 60 and has not been on HRT, then we start looking at risk factors for cardiovascular disease or stroke.

因此，如果我接诊的患者已经绝经 10 多年，或者年龄超过 60 岁，并且尚未接受激素替代疗法，那么我们就会开始研究心血管疾病或中风的危险因素。

And so we're looking at her blood pressure, her lipids, her cholesterol and triglycerides and looking for things that are going to put her at higher risk.

因此，我们正在检查她的血压、血脂、胆固醇和甘油三酯，并寻找会使她面临更高风险的因素。

She's lost probably the maximum cardiovascular benefit, but we don't want to put estrogen on top of severe atherosclerotic disease.

她可能失去了最大的心血管益处，但我们不想将雌激素置于严重的动脉粥样硬化疾病之上。

So if she has abnormal cholesterol, I'm going to send her for a calcium cardiac score.

因此，如果她的胆固醇异常，我就会送她去做钙心脏评分。

I want to see if there's calcified plaques around her heart.

我想看看她的心脏周围是否有钙化斑块。

I may even if stroke is a risk, we may even send her for an ultrasound looking at the intimal thickness of the carotids.

即使有中风的风险，我们甚至可能会送她去做超声波检查，检查颈动脉的内膜厚度。

So if those are normal or low risk, then we will talk about the benefits of what would the benefits be for her after the age of 60.

因此，如果这些都是正常或低风险，那么我们将讨论 60 岁后对她有什么好处。

Well, we probably lost the best of the cardiovascular protection, but it will always protect her bones.

好吧，我们可能失去了最好的心血管保护，但它永远会保护她的骨骼。

It will always protect her genital urinary system.

它将始终保护她的生殖泌尿系统。

It will always protect her skin.

它将永远保护她的皮肤。

I mean, there's things that estrogen will do for us forever and then let her make the decision.

我的意思是，雌激素会永远为我们做一些事情，然后让她做出决定。

Certainly if she's still symptomatic, meaning hot flashes or things we can easily identify that we know estrogen will help with, but that first 10 year window is kind of critical for the preventative benefits, but it doesn't mean she's not going to benefit forever.

当然，如果她仍然有症状，即出现潮热或我们可以轻松识别的症状，而我们知道雌激素会有所帮助，但第一个 10 年窗口期对于预防效果至关重要，但这并不意味着她不会永远受益。

Now, when do we stop?

现在，我们什么时候停止？

Used to be doctors make up numbers, three, 10 years, whatever.

过去都是医生编造数字，三年、十年等等。

If she's been on it since early in her menopause and has not developed any of these diseases and she wants to keep going, we're going to keep her on.

如果她从更年期早期就开始服用，并且没有患上任何这些疾病，并且她想继续服用，我们会让她继续服用。

I will probably die with my estradiol patch on if I don't develop a reason to take it off.

如果我没有理由把它取下来，我可能会带着雌二醇贴片死去。

I know it's protecting me in so many levels and I want to keep that going

我知道它在很多层面上保护着我，我想继续下去

Andrew Huberman:

安德鲁·休伯曼：

In so many ways.

在很多方面。

It sounds very similar to testosterone replacement therapy in men.

这听起来与男性睾酮替代疗法非常相似。

The idea is that people go on and

这个想法是人们继续并

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Don't, yeah, well, you stop at 70.

别，是的，好吧，你到了70就停下来了。

Why would you do that if you didn't develop a contraindication to it?

如果您没有出现禁忌症，为什么要这样做？

Andrew Huberman:

安德鲁·休伯曼：

Very clear and potentially very actionable answer.

非常明确且可能非常可行的答案。

Thank you.

谢谢。

A number of the questions related to the relationship between menopause hormone therapy and mental health or mental wellbeing, but let's just keep it simple for now and ask what are the things that women can do in order to optimize their mental health in perimenopause and menopause and that they can do to offset any mental health issues that might arise during perimenopause and menopause?

许多问题与更年期激素治疗和心理健康或心理健康之间的关系有关，但现在让我们简单地问一下，女性可以做哪些事情来优化围绝经期和更年期的心理健康，以及她们可以做些什么来抵消围绝经期和更年期期间可能出现的任何心理健康问题？

And there's a reason why I asked about those two things separately.

我单独询问这两件事是有原因的。

One is just to Perry's

一件是去佩里家的

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Different than menopause for mental health.

心理健康与更年期不同。

So it was a great question.

所以这是一个很好的问题。

So I just went to APOs Menopause conference in Chicago and there was a whole section on mental health and it was neuroscientists, psychiatrists and menopause specialists all up there discussing the latest data.

所以我刚刚参加了在芝加哥举行的 APO 更年期会议，其中有一整个部分是关于心理健康的，神经科学家、精神病学家和更年期专家都在那里讨论最新的数据。

It was so fascinating.

真是太令人着迷了。

And so there really is a big difference as far as mental health for what's happening in perimenopause and what's happening post menopause.

因此，围绝经期和绝经后的心理健康确实存在很大差异。

And as we talked about earlier in perimenopause, we have that hormonal zone of chaos and we see this in the Australian data.

正如我们之前谈到的，在围绝经期，我们有一个荷尔蒙混乱区，我们在澳大利亚的数据中看到了这一点。

It's a four times risk of mental health disorders, especially depression, and then in post menopause, a lot of these things tend to stabilize or get better probably because just the estrogen is bottomed out and the brain is not having to deal with these fluctuations.

患精神健康疾病（尤其是抑郁症）的风险是绝经后的四倍，然后在绝经后，很多这些事情往往会稳定或好转，可能是因为雌激素触底而大脑不必处理这些波动。

So we think that the data is looking like the best treatment for the mental health issues in perimenopause is going to be estrogen for stabilization and not the traditional SSRIs SNRIs, the antidepressants and the anxiety meds.

因此，我们认为，从数据来看，围绝经期心理健康问题的最佳治疗方法将是稳定雌激素，而不是传统的 SSRIs、SNRIs、抗抑郁药和焦虑药物。

Andrew Huberman:

安德鲁·休伯曼：

Not incidentally, one of the more common questions was, in this case, very specifically worded.

并非偶然，在这种情况下，最常见的问题之一的措辞非常具体。

I've been on HRT for five years and I'm 61.

我已经 61 岁了，已经接受 HRT 五年了。

I feel great, but how long is it okay to be on them?

我感觉很好，但是可以使用多久呢？

Seems like I hear conflicting opinions.

似乎我听到了相互矛盾的意见。

Well, we just heard a very straightforward opinion from you, so thank you for that.

嗯，我们刚刚听到了您非常直接的意见，所以谢谢您。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

As long as you want to be, as long as you're still healthy,

只要你愿意，只要你还健康，

Andrew Huberman:

安德鲁·休伯曼：

How can I stop waking up in the middle of the night?

怎样才能不再半夜醒来？

This is a problem since entering menopause.

这是进入更年期以来的一个问题。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

So we see sleep disruptions definitely from not only from the vasomotor symptoms which will wake you up.

因此，我们看到睡眠中断肯定不仅仅来自于会唤醒您的血管舒缩症状。

Okay?

好的？

If we can get those under control, your sleep function should not be affected by that.

如果我们能够控制这些情况，您的睡眠功能就不会受到影响。

What we're seeing though is people even with HRT, even with estrogen, are still having middle of the night awakenings or racing thoughts or having they get up to pee or something in the middle of the night and they can't go back to bed usually because their brain is going on.

但我们看到的是，即使使用了激素替代疗法（HRT），即使使用了雌激素，人们仍然会在半夜醒来或思绪万千，或者在半夜起床撒尿或做其他事情，并且通常无法回到床上，因为他们的大脑正在运转。

What we found is that progestin probably through the effects of gaba, is very effective at settling your brain down and allowing for sleep.

我们发现，孕激素可能通过伽巴的作用，非常有效地让你的大脑平静下来并促进睡眠。

So I'm having my patients take their progesterone orally at night before they go to bed, and we're seeing better sleep with that.

所以我让我的病人在晚上睡觉前口服黄体酮，我们发现这样可以改善睡眠。

And that was also something covered in detail.

这也是详细介绍的内容。

I was so excited by the neuroscientist as part of her area of research that they are showing clearly and she can point to the neuroreceptors of where that's happening, that progesterone seems to be really protective for our sleep.

作为她研究领域的一部分，我对这位神经科学家感到非常兴奋，他们清楚地表明，她可以指出发生这种情况的神经感受器，黄体酮似乎确实对我们的睡眠有保护作用。

Now, take hormones off the table, sleep hygiene is still hugely important and I need to see the studies to prove it, but I'm telling you, we do not tolerate alcohol like we did.

现在，不再考虑激素，睡眠卫生仍然非常重要，我需要看到研究来证明这一点，但我告诉你，我们不像以前那样容忍酒精。

Premenopausal women are in at least 90%.

绝经前女性至少占90%。

Every time I post about it online, I see thousands of comments of I quit.

每次我在网上发布有关此事的信息时，我都会看到数千条关于我戒烟的评论。

I had to give it up, I cannot sleep.

我不得不放弃，我无法入睡。

And even in my own life, if I choose socially to have more than a glass of wine, I'm giving up sleep.

即使在我自己的生活中，如果我选择在社交场合喝的不仅仅是一杯酒，我就放弃了睡眠。

It is a choice.

这是一个选择。

I'm choosing not to sleep that night.

我选择那天晚上不睡觉。

I will wake up 2 23, 3 35, whatever time in the morning sweating and I'm like, too much champagne at New Year's or whatever.

我会在2点23分、3点35分醒来，无论早上什么时候出汗，我都会想，新年或者其他什么时候喝太多香槟了。

So that is a choice, and it's something I counsel my patients about.

所以这是一个选择，也是我向我的患者提供的建议。

You probably can't tolerate alcohol like you used to.

您可能无法像以前那样忍受酒精。

Aging's a factor here.

衰老是这里的一个因素。

Our body composition changes and there's probably something hormonally that's going on we don't understand yet, but you choose this, you're going to choose not to sleep more than likely.

我们的身体成分发生了变化，荷尔蒙可能正在发生一些我们还不了解的事情，但你选择了这个，你很可能会选择不睡觉。

Andrew Huberman:

安德鲁·休伯曼：

Interesting.

有趣。

I wonder whether or not estrogen modulates the alcohol dehydrogenase enzyme, but time will tell.

我想知道雌激素是否会调节乙醇脱氢酶，但时间会证明一切。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

I haven't seen the data yet, but I'm sure it's coming.

我还没有看到数据，但我确信它即将到来。

Andrew Huberman:

安德鲁·休伯曼：

Here's an interesting one.

这是一个有趣的。

How can men help their female loved ones navigate these stages?

男人如何帮助他们的女性亲人度过这些阶段？

Get that a lot.

得到很多。

Yeah, you get that question a lot

是的，你经常被问到这个问题

Mary Claire Haver:

玛丽·克莱尔·哈弗：

And it's great, and it always comes on when I'm being interviewed by a male, when I'm interviewed by a female, they're wonderful, but they have their own experience and they have to talk about it, and that's fine.

这很棒，当我接受男性采访时，当我接受女性采访时，他们总是很棒，但他们有自己的经验，他们必须谈论它，这很好。

My job is women have to unpack their menopause trauma to me, but the men are just so curious and just have so many questions.

我的工作是女性必须向我解开她们的更年期创伤，但男性们只是很好奇并且有很多问题。

And then how can I support a partner or my mom or whomever in my life who's dealing with this?

那么我该如何支持我的伴侣、我的妈妈或我生命中正在处理这个问题的任何人呢？

One is acknowledge that this is happening and try to educate yourself.

一是承认这种情况正在发生，并尝试自我教育。

There's my book, other books, there's lots of information now on the internet about the subject, but she's going through a transition that is rocking her world more than likely and is affecting her brain, her bones, her heart, her kidneys, her skin, her ability to relate, her ability to tolerate, and it's probably going to affect her relationship in some way.

有我的书，其他的书，现在互联网上有很多关于这个主题的信息，但她正在经历一个转变，这很可能会震撼她的世界，影响她的大脑、她的骨骼、她的心脏、她的肾脏、她的皮肤、她的人际关系能力、她的容忍能力，而且这可能会以某种方式影响她的关系。

Go there with her, go to the appointments with her, be there to advocate for her, be a partner through this with her because you will get her back, but it's going to take changing the way that you address things.

和她一起去那里，和她一起去约会，在那里为她辩护，成为她的合作伙伴，因为你会让她回来，但这需要改变你处理事情的方式。

Andrew Huberman:

安德鲁·休伯曼：

A couple of questions about how to rekindle libido.

关于如何重新点燃性欲的几个问题。

Oh yeah.

哦，是的。

This person in particular says it's packed its bags and moved out since they started menopause.

这位人士特别表示，自从他们开始更年期以来，他们就收拾行李搬走了。

They're reporting their individual experience, but you touched on testosterone therapy earlier.

他们正在报告他们的个人经历，但您之前提到了睾酮疗法。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

So any woman in her menopause journey at any time, there's a 50% sexual dysfunction rate, meaning she's not happy with whatever's going on.

因此，任何处于更年期的女性，在任何时候，都有 50% 的性功能障碍发生率，这意味着她对所发生的一切都不满意。

Now, when we look at the buckets where sexual function fall into, we have orgasmic disorder now in menopause, when we lose blood flow to the area, people can have delayed orgasms or less.

现在，当我们观察性功能所属的区域时，我们在更年期就会出现性高潮障碍，当我们失去流向该区域的血液时，人们的性高潮可能会延迟或更少。

The peak of the orgasm is lower, less vibrant orgasms, for lack of a better word.

高潮的峰值较低，高潮的活力较小，因为没有更好的词来形容。

They have decreased blood flow to the area.

他们减少了该区域的血流量。

They lose elasticity.

他们失去弹性。

So pain is another bucket.

所以痛苦是另一个桶。

It hurts.

好痛。

The skin gets torn.

皮肤被撕裂。

It's very fragile, it's very friable.

它非常脆弱，非常易碎。

So vaginal estrogen therapy can help there.

因此阴道雌激素治疗可以提供帮助。

There is arousal disorders where you want to do it, but the blood's not getting where it needs to go, so you're not having all the arousal type symptoms.

存在一些你想要做的性唤起障碍，但血液没有到达它需要去的地方，所以你不会出现所有的唤起类型症状。

So sometimes Viagra, sildenafil, topical sildenafil can be helpful there, but the most common thing that women have is HSD or of course relationship disorder.

因此，有时伟哥、西地那非、外用西地那非可能会有所帮助，但女性最常见的问题是 HSD，当然还有人际关系障碍。

You don't love your partner, you don't feel supported.

你不爱你的伴侣，你感觉不到支持。

It's going to be hard to

这将会很难

Andrew Huberman:

安德鲁·休伯曼：

Relationship disorder.

关系紊乱。

Yeah, relationship the official term.

是的，官方术语“关系”。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

But then HSDD is hypoactive sexual desire disorder.

但 HSDD 是性欲减退症。

That's in the brain.

那是在大脑里。

And so first thing I ask is, did you use to have a good libido or a drive?

所以我首先要问的是，你过去是否有良好的性欲或动力？

Yes.

是的。

And you have a good relationship with your partner.

而且你和你的伴侣关系很好。

It doesn't hurt.

它不疼。

Have to rule out the other things.

必须排除其他事情。

That's where testosterone comes into play.

这就是睾丸激素发挥作用的地方。

That is those patients, it does tend to help.

那就是那些病人，它确实会有所帮助。

There are two FDA approved medications for libido.

FDA 批准了两种治疗性欲的药物。

One is VIIs.

一种是VII。

It's an injection you give yourself and actually works for men as well about 30 minutes before

这是您自己进行的注射，实际上对男性也有效，大约需要提前 30 分钟

Andrew Huberman:

安德鲁·休伯曼：

It's in the alpha melanocyte stimulating

它刺激α黑素细胞

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Hormone pathway.

激素途径。

Yeah, so melanocortin and then there is Addie, A-D-D-Y-I works at the level I think of dopamine in the brain, so it's more in the family of SSRIs.

是的，黑皮质素和艾迪，A-D-D-Y-I 的作用水平与我认为大脑中的多巴胺水平相同，所以它更多地属于 SSRIs 家族。

So it affects neurotransmitter.

所以它会影响神经递质。

And so you take that every day and it works.

所以你每天服用它，它就会起作用。

It was only studied in premenopausal women, but it does.

它只在绝经前女性中进行过研究，但确实如此。

It's modest, but it does seem to have an effect.

虽然很不起眼，但似乎确实有效果。

But most of my patients, because testosterone has so many other benefits and the cost to get it compounded in Texas, this may be 30 bucks a month.

但我的大多数患者，因为睾酮有很多其他好处，而且在德克萨斯州复合睾酮的成本可能是每月 30 美元。

So it's really reasonable.

所以这确实是有道理的。

And the lyce and the ADDIE can be very expensive and usually not covered by insurance.

而且 lyce 和 ADDIE 可能非常昂贵，而且通常不在保险范围内。

So because of cost and potential other effects, most of my patients choose testosterone.

因此，由于成本和潜在的其他影响，我的大多数患者选择睾酮。

If it's HSDD.

如果是HSDD的话。

Andrew Huberman:

安德鲁·休伯曼：

I see.

我明白了。

This is a question about the side effects associated with ES hormone replacement therapy.

这是一个关于 ES 激素替代疗法相关副作用的问题。

In this particular instance, the person says, what are the best alternatives to estradiol?

在这种特殊情况下，该人士说，雌二醇的最佳替代品是什么？

I've tried tiny amounts and the side effects, in this case, skin rashes and hives are what they are

我尝试过少量和副作用，在这种情况下，皮疹和荨麻疹就是它们

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Describing.

描述。

So I wonder if it's the patch.

所以想知道是不是补丁的问题

So there's a certain percentage of patients who, it's not the estradiol, it's actually the adhesive in the patch.

所以有一定比例的患者，不是雌二醇，而是贴片中的粘合剂。

They will have a reaction to it.

他们对此会有反应。

So one is try an alternative form.

所以我们要尝试一种替代形式。

Another thing that one of the members on my team saw in her chat group is they get the flon, naso cortico nasal spray over the counter, and they spray it on and let it dry.

我团队的一位成员在她的聊天群中看到的另一件事是，他们在柜台上买到了氟里昂鼻皮质鼻喷雾剂，然后将其喷洒并使其干燥。

Then they put the patch on and it decreases the risk of the reaction to the, I dunno if that lasts forever, but I thought that was a cool thing to know about.

然后他们贴上补丁，它降低了反应的风险，我不知道这种情况是否会永远持续下去，但我认为这是一件很酷的事情。

But what I typically do for my patients is change them to an alternative form.

但我通常为我的病人做的就是将他们改变为另一种形式。

Andrew Huberman:

安德鲁·休伯曼：

Interesting.

有趣。

Thank you for that.

谢谢你。

They went on to ask about trying a new supplement called Eque, E-Q-U-E-L-E.

他们接着询问是否可以尝试一种名为 Eque、E-Q-U-E-L-E 的新补充剂。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Think I read about that one.

我想我读过那篇文章。

Again, I don't know what's in equal, but again, not really robust studies, but most of these things are not harmful.

再说一次，我不知道什么是平等的，但同样，这不是真正可靠的研究，但其中大多数都是无害的。

But you may just, it may be a little snake oil, throw your money away.

但你可能只是，这可能是一点万金油，把你的钱扔掉。

Really, the thing that's going to fix the problem for most women is restoring your estradiol.

事实上，对于大多数女性来说，解决这个问题的办法就是恢复雌二醇。

Andrew Huberman:

安德鲁·休伯曼：

Yeah, because there were other questions about wild yam and things more in the supplement space as well as things like acupuncture and herbal medicine.

是的，因为还有其他关于野生山药的问题，以及补充领域的更多问题，以及针灸和草药等问题。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

So acupuncture can really be helpful, but again, it's hard to access and can be expensive for a lot of patients it, it's not treating the root cause, but it definitely can help you deal with some of the symptoms and make you more comfortable.

所以针灸确实很有帮助，但同样，它很难获得，而且对很多患者来说可能很昂贵，它不能治疗根本原因，但它绝对可以帮助你处理一些症状，让你更舒服。

Andrew Huberman:

安德鲁·休伯曼：

And then last question, how best to attack.

最后一个问题，如何最好地进攻。

And here I'm quoting attack the fat distribution problem at this time.

而这里我引用的是此时攻击脂肪分布问题。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Yeah, you need a multifactorial approach to visceral fat.

是的，你需要采取多因素的方法来控制内脏脂肪。

So nutrition, exercise, women on HRT have less visceral fat.

所以营养、运动、接受HRT的女性内脏脂肪较少。

Those are kind of the key things.

这些是关键的事情。

And the way you approach your nutrition with the exercise, with the stress reduction, getting those cortisol level down are going to make you healthier in every other way as well.

通过锻炼、减轻压力、降低皮质醇水平来获取营养的方式也会让您在其他方面变得更健康。

Andrew Huberman:

安德鲁·休伯曼：

Great.

太棒了。

Well, Dr. Mary Claire, thank you so much for giving us just a wealth of knowledge about perimenopause, menopause, really explaining what those are clearly for the first time on this podcast and really illustrating the things that people can do to think about these stages of life and to, I dunno if I should say tackle or to dance with the stage of life, whatever term one prefers in order to offset the negative effects.

好吧，玛丽·克莱尔博士，非常感谢您为我们提供了有关围绝经期、更年期的丰富知识，在这个播客中第一次真正清楚地解释了这些知识，并真正说明了人们可以做些什么来思考这些人生阶段，我不知道我是否应该说“应对”或“与人生阶段共舞”，无论人们喜欢用什么术语来抵消负面影响。

And it sounds like, in fact, it's very clear based on what you've told us, that there are real levers of control including hormone replacement therapy, but other things as well, nutrition, exercise.

事实上，根据您告诉我们的情况，听起来很清楚，确实有控制手段，包括激素替代疗法，但还有其他东西，营养、锻炼。

It sounds like when we put all these together, there's almost like a mindset around perimenopause and menopause that you are promoting, which is one of real agency, that this is not something that is going to bury us mentally and physically.

听起来，当我们把所有这些放在一起时，几乎就像您所提倡的围绕更年期和更年期的一种心态，这是真正的代理之一，这不会在精神和身体上埋葬我们。

That's something that really can be worked with.

这是真正可以合作的东西。

And I just want to say on behalf of myself, because I've learned so much from you here and the listeners and viewers of the podcast, thank you for the information today.

我只想代表我自己说，因为我从你们这里以及播客的听众和观众那里学到了很多东西，感谢你们今天提供的信息。

Thank you for your clinical work.

感谢您的临床工作。

Thank you for your ongoing research into this area for attending these conferences and learning so much about it so you can bring us the latest and thanks for your public education efforts because they are really making a tremendous difference.

感谢您对该领域的持续研究，参加这些会议并了解了很多相关知识，以便为我们带来最新的信息，并感谢您的公共教育努力，因为它们确实产生了巨大的影响。

Mary Claire Haver:

玛丽·克莱尔·哈弗：

Thank you.

谢谢你。

Andrew Huberman:

安德鲁·休伯曼：

Thank you for joining me for today's discussion with Dr. Mary Claire Haver.

感谢您参加今天与玛丽·克莱尔·哈弗博士的讨论。

To learn more about her work, please see the link to her website in the show note caption, as well as the link to her terrific book, the New Menopause, navigating Your Path Through Hormonal Change With Purpose, power, and the Facts.

要了解有关她工作的更多信息，请参阅节目注释标题中她的网站的链接，以及她的精彩著作《新更年期》的链接，《以目的、力量和事实引导你的荷尔蒙变化之路》。

If you're learning from and or enjoying this podcast, please subscribe to our YouTube channel and follow us on both Spotify and Apple.

如果您正在学习或喜欢这个播客，请订阅我们的 YouTube 频道并在 Spotify 和 Apple 上关注我们。

That's a terrific zero-cost way to support us.

这是支持我们的绝佳零成本方式。

In addition, you can leave us up to a five star review.

此外，您还可以给我们留下五星级的评价。

Please also check out the sponsors mentioned at the beginning and throughout today's episode.

另请查看今天节目开头和整个节目中提到的赞助商。

That's the best way to support this podcast.

这是支持这个播客的最佳方式。

And if you have questions for me or comments about the podcast or guests or topics that you'd like me to consider for the huberman Lab podcast, please put those in the comment section on YouTube.

如果您对我有疑问，或者对播客、嘉宾或主题有任何意见，希望我为 huberman Lab 播客考虑，请将这些意见放入 YouTube 的评论部分。

I do read all the comments if you're not already following me on social media.

如果您还没有在社交媒体上关注我，我会阅读所有评论。

I am huberman Lab on all social media platforms, so that's Instagram X, formerly known as Twitter, LinkedIn, Facebook, and Threads, and on all those platforms, I discuss science and science related tools, some of which overlaps with the content of the huberman Lab podcast, but much of which is distinct from the content on the huberman Lab podcast.

我是所有社交媒体平台上的 huberman Lab，即 Instagram X，以前称为 Twitter、LinkedIn、Facebook 和 Threads，在所有这些平台上，我讨论科学和科学相关工具，其中一些与 huberman Lab 播客的内容重叠，但其中大部分与 huberman Lab 播客上的内容不同。

Again, that's Huberman lab on all social media channels.

同样，这是所有社交媒体渠道上的休伯曼实验室。

If you haven't already subscribed to our Neural Network newsletter, our neural network newsletter is a zero cost monthly newsletter.

如果您还没有订阅我们的神经网络时事通讯，我们的神经网络时事通讯是零成本的每月时事通讯。

That includes podcast summaries as well as protocols in the form of brief one to three page PDFs that cover everything from neuroplasticity and learning to how to improve your sleep, to optimizing dopamine, deliberate cold exposure, deliberate heat exposure.

其中包括播客摘要以及简短的一到三页 PDF 形式的协议，涵盖从神经可塑性和学习到如何改善睡眠，到优化多巴胺、有意冷暴露、有意热暴露等一切内容。

We have a foundational fitness protocol, all of which is available at completely zero cost.

我们有一个基本的健身协议，所有这些协议都是完全零成本的。

To sign up, you simply go to huberman lab.com, go to the menu tab, scroll down to newsletter, and enter your email.

要注册，您只需访问 huberman lab.com，转到菜单选项卡，向下滚动到新闻通讯，然后输入您的电子邮件。

And I should mention that we do not share your email with anybody.

我应该指出的是，我们不会与任何人分享您的电子邮件。

Thank you once again for joining me for today's discussion about perimenopause and menopause with Dr. Mary Claire Haver.

再次感谢您今天与玛丽·克莱尔·哈弗博士一起参与围绝经期和更年期的讨论。

And last but certainly not least, thank you for your interest in science.

最后但并非最不重要的一点是，感谢您对科学的兴趣。