Havva Mahler on the Chinese medicine perspective of perimenopause and menopause

Bree: I'm recording this intro right before taking a little solo retreat. It's a first for me, I'm going into the jungle by myself with my journals, my yoga mat, and a book, The Chalice And The Blade by Riane Eisler. Uh, the book looks at the history of human culture. Through a lens that we don't really study in school, the LA Weekly published a review saying that it may be the most significant work published in all of our lifetimes.

It's not a new book. It's 30 years old and I can beat myself up and say, why haven't you read it until now? But the truth is I wasn't ready until now to read it. It would probably sit on my bedside for three years if I weren't isolating myself so completely in an effort to slow down, to examine, to make room for transformation.

But now is the time. So my coaching business is called The Lovely Unbecoming. And what I do is I guide clients to recognize where they have been conditioned to stay small, to guard themselves against danger, but in doing they stop themselves from living their fullest, most joyful, most creative, meaningful lives.

And what I found is that when people are supported and held in a place of love as they explore their most unbecoming selves, it gives them an opportunity to reorganize, to build healthier structures, and to move forward. It's not about rejecting everything you know and love. It's about finding the space, the wherewithal and the courage to move beyond it.

And that's what I'm hoping happens in these conversations about perimenopause too. These conversations have really had me mulling over the role of culture and our understanding of pretty much everything from gender and sexuality, to our shifting roles in society as we age, to even the notion of what is normal in our physical or emotional changes.

And so I really, really loved this conversation that you're about to hear with my friend Havva Mahler. Havva is a Chinese medicine practitioner and an intentional health and wellness coach. She's based in Israel, where she lives with her two kittens. So I really appreciated a very different cultural vantage point on aging.

And so as you listen, take a moment to just consider. You don't have to reject, just consider your cultural understanding of yourself, of aging and time. You're not alone, we're in this together. Enjoy. 

Havva I'm so happy to have you here today. Can you tell us where you are in the world right now? 

Havva: Thank you. It's great to be here. In spirit, I'm with you, but physically I live in Israel. I'm in the city of Beersheva. I also work here. I have a private clinic for Chinese medicine and other holistic methodologies. I think we say in English, I am a native English speaker, but I don't work in English. And so my technical, words might be a little bit off 

Bree: Well, we'll keep that in mind. And it's actually great because I think menopause and perimenopause are universal. Humans with ovaries around the world, go through perimenopause and menopause and, and so it's actually wonderful that if any limitations around language or differences in communication in the lexicon of perimenopause arise, then it gives us an opportunity to explore that and be curious around it. 

Havva: Absolutely. I think there's so much to learn in the different ways that different languages talk about things. And there's actually a saying in Hebrew, biblical studies, they say all translation is interpretation because you can't change the language without changing the viewpoint and the perspective that you look at something from. And so anytime you translate something, you have to shift it, not only into your own language but into your own viewpoint.

Bree: I love that concept and I'm excited to be able to explore this phase of life with you, getting your perspective, both from an international and language difference, but also because we're going to get a Chinese medicine perspective today. With all of my guests, I'm asking this, how old are you and where are you along the perimenopause menopause spectrum?

Havva: Well, I am 35. my grandmother did not go through menopause until she was 72. and my mother sadly passed away two years ago. She had not yet reached menopause. So, personally, I'm not expecting it anytime soon. But I can always be surprised. I know that my grandmother's grandmother had 14 children.

She kept having children. reasonably advanced in years. So it does seem to be something that my family, takes longer to get there perhaps than some other people. 

Bree:I think that we often think of having a very specific timeframe or that there are certain constants in life. And really what we have here is a bell curve, right?

So it sounds like your family is on one extreme end of the bell curve. 

Havva: I actually remember, when I was studying Chinese medicine, when we were studying the menstrual cycle, we were told, you know, so there's technically these rules and they say that this is normal and this isn't. And if the cycle is shorter than this, then it's irregular, or if it's longer than this, but you can't forget that not only is every person different, everyone's genetics are different. And so my teacher said before you can say that someone's cycle is wrong, or, you know, for her, or irregular, you have to ask about your sister and her mother and her grandmother, if she knows, because maybe it's just something that happens with a specific group of people --

Bree: And in your practice, how do you define perimenopause and menopause? 

Havva: Oh, that's interesting. I don't think I've ever defined it. I accept what women tell me. Like for myself, I've never said to a woman, I think you're starting to experience perimenopause. Women will either come in and tell me, like, you know, “I'm menopausal / I'm perimenopausal. My doctor says I'm menopausal” or they'll tell me “I have XYZ symptoms and I don't want them anymore. Please make them go away”  I very rarely try and tell my patients things about their bodies unless they ask for my point of view on something. And so, I've never actually thought about, that exact question. In Chinese medicine, we would look at becoming perimenopausal as the period in a woman's life where there's a change in the balance of energies in her body. Chinese medicine is very, gendered so I know that this is, not the most inclusive language, but, there's considered to be specific cycles of energy that are different in men's and women's bodies.

According to Chinese medicine around the age of 50, women will start to produce less yin energy, or more accurately will use up their yin energy where the yin represents the feminine, the receptive, the, more spiritual and emotional -- the opposite of the yang which is the masculine energy. And what I would normally see, what I would normally do is I would look at a woman's pulse. So I would look at her tongue. I would look at, her list of physical symptoms and see whether it looks like someone might be experiencing hot flashes because of a temporary change in her energy, or if it seems like this is part of an overall picture of moving into the next stage of life, 

Bree: I've often wondered what are you looking for on the tongue?

Havva: Okay. so. The special thing about the tongue. If you think about it is it's the only muscle of the body that we can look directly at without it being covered by skin. And so when you look at the tongue, we can see, we look at the color. First of all, if someone's anemic, you can generally see it in their tongue. If someone has issues with, blood not flowing well, you can see it. At the time it's very pale or on the other hand, the tongue is dark or it's purple. 

We look at the size and the shape of the tongue. If you see that the tongue is wider than that seems appropriate for that the shape of the mouth --and you can tell that because you'll see the little like scallop edges along the edge of the tongue, like the little teeth marks, then that indicates that the body isn't, perfectly capable of holding all of the muscles exactly in place. Right? There's some sort of flabbiness going on inside the body, which is incredibly normal, by the way.

Like, if people go look at their tongues, basically everyone has this, not everyone, like a third of the people I think have, have these teeth marks. I have them. it doesn't mean something's deadly wrong with you. on the other hand, the tongue is very, very narrow and it's, and it's, it's like narrow and pointed, but it looks very thick, like tall, then you can see that the body is holding it, the muscle in, and it's really tense. so we look at that. We look at the coating on the tongue, the fur or the moss, I think it's called in Chinese medicine English. And, what you're ideally looking for, is for there to be a light, and gentle coating of pale white-ish, fur. And again, we can tell different things from the colors.

Although, as one of my teachers told us, always make sure if you see someone whose tongue definitely looks like they have oral cancer to ask, did you have a grape popsicle before coming in today?

That's usually what it is 

Bree: That many people have grape popsicles?

Havva: Grape popsicles make tongues look really like really unhealthy. There are all sorts of other things, licorice. 

Bree: And I am a big fan of black licorice, I have to say. So, so I will keep that in mind. The next time I go to my acupuncturist to make sure that I don't have black licorice before I go.

Thank you for sharing that. It's been a question that I've had for a while. So if, if during perimenopause and menopause, there's a shift for moving from more Yin to less Yin, what is the goal with the work that you do and in helping women who are experiencing unwanted feelings, sensations, shifts around this.

Havva: Yeah, my goal is to help women go through the transition without experiencing, pain or suffering, or unpleasantness. And I think it is so important to tell people. You don't have to suffer just because the world thinks it's normal for something to hurt. You know, I had a patient today, a patient coming in with menstrual pains.

And I asked her how bad are the pains today? And she said, oh, you know, they're normal. And I like, I wish women could dream of a world where not having pain was normal and any pain is something that we should take care of. So when a person is perimenopausal, there are going to be changes in the body system.

There's going to be changes in hormones – there’s going to be changes in the way the body reacts to external stimuli, maybe like heat and cold, but there doesn't necessarily have to be suffering. You know, you can have like this exciting new adventure of “Huh! Well this is what my body's doing today” without, you know, suffering from pain or, lack of ability to sleep or to function or to focus, you know, just because change is happening doesn't mean to have it has to hurt. 

Bree: Yes. And I, I love the shift in perspective from, just because something is ubiquitous doesn't mean that it's normal, right? 

Havva: Yes.

Bree: And thank you for that because I, I also think, although we say, you know, normalize this and normalize that -- that's such a popular thing right now, we have normalized suffering. And, in so doing, maybe we limit our ability to release from suffering. Suffering doesn't have to be normal. 

Havva: Yeah. I mean, suffering is literally your body's way of telling you that something isn't right. And needs to be treated. That's what it means. 

Bree: Pay attention to this, yes.

Havva: Exactly

Bree: So, are there any ways that you can think of where Chinese medicine maybe has a very different approach from a Western medical model around this transit?

Havva: That's an interesting question. I don't feel sufficiently an expert in Western medicine to stay exactly what the Western medical model is. I mean, I've, I've certainly, I studied it in school. I see what happens, what my patients go through, and what happens to them. But I can't say exactly what's going on in doctors' minds or in the experts' minds.

I think that one area where Chinese medicine maybe has a very, very different perspective is about the emotional upheavals that often happen, or at least --My perspective may be skewed because I'm obviously seeing people who are suffering and want to change, but the emotional upheavals that can happen. Although presumably, all the people who aren't suffering and, or having a perfectly happy situation don't end up in my clinic.

So I don't want to say like, everyone gets just cause everyone I see has this, but, I think from what I've seen that in Western society as a whole, any sort of emotional changes and experience, or in reactions are considered like a sign that there's something wrong with the person who's experiencing them, like, “Oh, don't mind her. She's just menopausal”. Where in Chinese medicine, we can say, okay, you know, this emotional reaction is different than what you may have had if this had happened a year ago, it doesn't necessarily mean it's wrong. And in fact, one of my good and advanced teachers told me that this whole concept of PMS and of like women freaking out when they go through menopause, it's in a particular way, especially for women of an older generation, at least in my area where, you know, there's the good housewife who takes care of everyone and is always there for her husband and her kids.

It was like, this is a socially acceptable chance to just blow your top and scream at everyone and say what you actually want and demand that people pay attention to you and all these things that you were never allowed to do normally. And so a lot of times I think that emotional upheaval is a perfectly normal expression of things that were repressed, consciously or subconsciously beforehand. And so I don't necessarily see that as something that needs to be treated unless it's bothering the patient. If the patient isn't happy with it, then obviously we will try and even that out and balance the energies in some way where that emotion can be expressed perhaps in a calmer or slower manner. Slower release of the emotion.

Bree: Havva, what I'm hearing there is that if it feels like it's uncomfortable for the human who is experiencing this, if a person who's going through, menopause is having a lot of emotional lability or feeling angry or upset and it's deeply disturbing, they feel like it's really interfering with their relationships and ability to function, then there's an opportunity to try to temper it. But, but it's also an opportunity, as a natural, progression in life to speak up, to say things that need to be said, to own a truth, and to take agency in a way that they might not have been able to before. I mean, really perhaps even on an emotional level, that they weren't at a place where they were ready to take on that kind of agency, but this heated or more passionate, opening of the eyes or relation to the world can also be of value.

Havva: Yes, it can be, it can be of value, or even if -- I think it's important to understand --even if the person experiencing it doesn't feel its value and just wants it to go away. It doesn't mean that it's fake or made up or comes from nowhere or it's just hormones. Right? If there's anger inside, the anger came from somewhere.

If there's frustration being expressed, the frustration came from somewhere and you know, if you don't want to deal with it now that's fine. But society and the world shouldn't get to say, you know, oh, she's just menopausal and so her emotions are even less real than, than usual. Than we usually treat women's emotions and experiences.

Bree: And I think that really gets us to this patriarchal view of women and a gendered perspective that can be really limiting. Perhaps if we had a culture – as we create a culture that appreciates what each phase in a woman's cycle can bring – right, in the menstrual cycle can bring, I mean, I think about, I'm going to go back a little bit.

Maybe, you know more about this than I do. I, I know just enough to be dangerous about a lot of things around menopause right now, but I heard something recently about how the workday, the idea of sort of a nine to five workday, and a workweek is really designed around a male biorhythm. And that women have very different biorhythms. So the workweek that is so androcentric is not optimal for a woman's workweek or work month. And that if we found a way or could create a work culture that worked with a woman's cycle, that there would be a whole different type of productivity that could happen.

Havva: Yeah, well, I, I honestly, I would quibble with one thing there. I think the current workday workweek system does not work for men either.

Might work slightly better for men than for women. 

Bree: Heard.

Havva: No. Absolutely. And there is a book that I love, technically it's about, the history of textiles, but it's a book called Women's Work The First 10,000 Years. And it describes the difference between, the pattern of labor that, is feasible for someone who is menstruating, giving birth to children, and breastfeeding, as opposed to someone who isn't. 

Why certain things end up being women's work or not women's work throughout different cultures. and, and yeah, the way that childbearers have been able to produce things, other than children, throughout all of human history has been different than people who are not bearing children and not nursing children and that, and so, we are set up to work at a different rhythm and at a different pace, and maybe with a different sense of focus. 

Bree: It's so interesting. And I'm going to link that book in the show notes for this. So if anyone wants to take a look at that, at Women's Work The First 10,000 Years --but who's counting?

Havva: It's one of my favorites, I think. So I think that everyone who read Sapiens, like the history of the human race, needs to read this book because this is the perspective that he missed.

Bree: I love it. 

Havva: I was reading that book. I was reading that book. I was visiting a friend of mine. She's had her fourth child, was breastfeeding at that point. And so I'm watching her. I was like, going there the weekend. So she's, you know, doing laundry and dishes and cooking while breastfeeding. And I'm meanwhile sitting there and reading this book cause like she's busy, so I can't talk to her right now cause she's trying to cook and breastfeed at the same time.

And I get to him saying. It's not really clear why throughout human history so few societies were led by women and it's like, I don't know maybe the fact that there is like, she has one less hand than her husband --

Bree: Absolutely 

Havva: for like 20 or 30 years. 

Bree: So, so from the, from the Chinese medicine perspective, then, is there a shift that happens?

You know, we have in this, in our Western culture, we have this view of women who are past the age of fertility. I hate even to say this, but it's there. Like it, it comes up time and time again that it's like, you're done. We're done with you. Like there's a cultural move into invisibility that we are no longer seen as sexual beings. And so in many ways, we are no longer seen as useful. I say this with like, you can't see me. I have so many air quotes and my eyes are rolling at the same time as I'm saying this, but that has been a view that has come up in many of these interviews. And this is sort of the, Western view of women who are post-menopausal, which is depressing and, and also honestly, as someone who wanted to be a superhero, I'm kind of excited about what being invisible could allow me to do. But, in Chinese medicine, is there a gift for that post-menopausal period? Is there a way that humans who are post-menopausal offer something new or a gift?

Havva: Absolutely. I'm actually, I'm just doing math here, cause I want to make sure not to mislead you because the Chinese actually have a very finely tuned system of what the gift is for each period in a woman's life or in a man's life. And there's like a different system for you, a slightly different system for each one. So I'm just sketching it out here. 

Okay. According to the Chinese system, because it's very orderly, like the system of Chinese philosophy and medicine is non-dualistic. It means we can accept two completely different ideas at the same time and just work with it. So on the one hand, we totally accept that each person is an individual and, they will develop in their own time at according to the influences that they experienced.

And on the other hand is this very rigid system of rules where like the ideal person will go through menopause at this stage and we'll move on to the next stage of this age. so the ideal female human being, we'll go through menopause at the age of 49 to 50, which is the age where. woman, specifically not a man moves from being in a phase of being connected to everyone around her and being in communication with everyone and, being in community to a phase of it's called like gathering in the harvest and getting to sit down and experience the pleasure of being done with work.

You get that for seven years, you don't get to stay there, after seven years, you move on to the phase of getting rid of everything that doesn't serve you. putting up boundaries everywhere and focusing in on what you want and on what's fair for you. And making ensure that you're being treated correctly and appropriately and justly.

And you get to spend seven years in that phase. I think at the age of 70, you move into the phase of just openly accepting the world and life and what comes of yourself and other people. so, so there's a process that you go through where, where the, the actual menopause is like one step along the way.

Bree: Havva, you are making me so excited about the rest of my life.

I turn 49 next year. Right? So that's like, yeah, man, 

Havva: Currently, currently we're sitting around the campfire, literally reaching out to people. You're forming connections. You're communicating with other members of the tribe, but pretty soon, you're going to get to pack up your harvest and you can go home if you want.

You can share it with people if you want, but you're no longer like mom who has to feed everyone. 

Bree: That's incredible. And it is liberating, releasing the need to impress or strive and moving into a place of receiving and enjoying the bounty of the harvest, right? And making one's own place, getting rid of what you don't need and, and, and appreciating what you do have and being in that place.

So I love that that aligned so beautifully and that it's part of the medicine. 

Havva: It absolutely is. And sometimes, I think it's very rare in our culture that people come in and ask for this. But traditionally in Chinese medicine, one of the things that you would treat, if someone doesn't feel like they're in alignment with what phase of life they're currently supposed to be in, I had air quotes to the supposed.

Bree: That's something to think about. Like, if you're feeling out of alignment, there are options, right. There's possibility for moving into that place. And what types of things do you do to bring people into alignment? And I would imagine this is at whatever phase of life, but maybe it's specific. 

Havva: There's so many different ways that you can affect a person's energy, a person's physical or emotional or mental health.

And I, I try to look at people, through the lens of, having like five different aspects to health. So look at physical health, emotional health, social, work-related, and environmental, like what's actually going on in their house. Usually when people come into me to the clinic, we're working more on the physical side, so there I'll do things like acupuncture, stimulating the body's own healing abilities to bring itself into a different energetic.

Can also use herbal medicine to nourish different energies in the body. You can also do things like give people exercises to do, someone who's not connecting to say that feeling of like the abundant harvest might find it beneficial to do things like gardening or baking or, you know, or not, if she wants if she's been gardening and baking for years and taking care of everything.

But, those are ways that you can kind of get in touch with that harvest feeling. you can also do things, you know, around the house, like making sure to create space for things that are important to you and maybe put some of the kids and the husband's stuff in a little less central area.

it can really be approached from any, any angle. It just depends on what will work for the person and what they're open to trying. Aomething that I have recommended to more than one person is just to go out into the woods and scream or to write letters and not send them. We're dealing more with like the emotional side of things.

There's really an unending ways to work with a person where, because they've worked with the body, but to work with the person as a holistic being as a whole. and so it really just depends. What, what works better for someone or where, what, on what level can you reach them? 

Bree: You just reminded me.

I, I have had, a really wonderful general practitioner who has a very holistic approach to medicine and I will never forget, after I had my second child, it was a little, it was a little while after it was, oh, it was post-postpartum right. I think she was probably. About 11 months old at that point.

And I just wasn't quite kicking back into myself yet. I didn't quite feel like myself. And he wrote down on a prescription note, watch comedies, laugh more, find something to laugh about every day. And so interesting how it really played to the people pleaser in me. Right. Just having it on a prescription pad, just having it written out by the doctor made it feel official. And because it is, it is medicine. 

Havva: Yeah. I've had patients call me and be like, could you prescribe to me not to go to my college reunion? Or like, something like that? Like, can you give me permission? 

Bree: Isn't that interesting. This seeking of permission? 

Havva: Yes. 

Bree: Well, I'm glad that you're offering permission, which of course is just validating self permission.

Right? 

Havva: That the validation is so important. It breaks my heart. I have so many patients, like not on a daily basis, but definitely on a monthly basis, I will see a patient and it's always a woman. I think, I think maybe I had this once with a man. They'll come in with some sort of physical pain.

Like my back pain, shoulder pain, pulled knee, and I'll be doing a physical examination, so I'll be touching, touching the area that hurts the meridians around it. And they'll say to me, "Right, it hurts?" And I'll say, well, you know, it makes sense that it would hurt. The muscle is incredibly tense and spasming, and it's pressing on this nerve and she'll go, “Thank you. I knew it hurt” or, or even “I didn't, I wasn't sure if it hurt.” People will tell me, like, “I didn't know if it hurt, cause the doctor told me it couldn't”.

Bree: Oh, oh, it hurts me to hear that. I can only imagine how it is to serve in that capacity when you see that we are so dependent on expert views that we forget to know ourselves and honor what we're feeling.

That must be really hard to see. 

Havva: Yeah. And I've, I've had people telling me that, like, that was, that was the entire treatment for them. Like I literally had a woman telling me, “as soon as you told me, it makes sense that this hurts because you know, this rib is connected to the area you got a bump in last month -- but because you explained it to me, that I was in pain and there was a reason for it, I could, I could like start getting better, but until my pain was acknowledged, it was not going to go away”.

Bree: Well, that absolutely makes sense because the reason for pain is to draw our attention to it. Right? 

Havva: Yeah. Well, have you, have you ever read the book -- There's No Such Thing As A Dragon. 

Bree: No. 

Havva: Oh my God. You have to.

Bree: Okay. That's also going in the notes 

Havva: It's a children's book. It's like eight pages long.

Bree: I can manage that.

Havva: A little boy finds a dragon, but his mother tells him there's no such thing as a dragon. And I do not know a single social worker who hasn't read this book. 

Bree: I think of when I would read to my daughters when they were younger, how it almost took me back to when I was a young girl and reading was so formative. I think of the characters that I read as a child who have shaped my entire life.

And I revisited that when I was reading to my daughters, the lessons were renewed in me. So as silly as it seems to read a book like There's No Such Thing As A Dragon. We all need to be reminded of our agency and, to listen to what our bodies are telling us, what our emotions are telling us, what we're finding.

Havva: Absolutely. 

Bree: So if you had to choose one thing that you could tell all of your patients who are entering into this phase of perimenopause, what would it be? 

Havva: Okay. other than the things we already covered, which is that you shouldn't have to suffer and listening to your body, I would say like really remember to take every opportunity to find joy and play in life because we don't start really getting old in the pejorative sense as long as we include the things that keep our minds and our emotions open and moving. And so watching comedies is great. Playing with kittens is great. Throwing a Frisbee if you can. but don't, don't let the joy fade away...

Bree: A few years ago, I made a choice to, Whenever I saw a curb. I would get up on it like a kid because you know, kids will get up on a curb and they'll pretend like they're on a balance beam.

And I would get up on the curb and here I was like 35 years old and I would jump up on every curb that I could find, or like around a fountain, if there was a curb, I would jump up on the, on that little ledge. Right. And, and I would walk on it and then I would hop off . I made that one shift. It was such a small thing to do. It was just a choice to introduce a little more play. For me, it had multiple, I thought, well, it will help with balance. You know, I had to justify it. It will help with balance. It'll help with play. It is truly amazing how just introducing one element of play in your life can give you a new lens to look through. So thank you for that, for those words of wisdom, because I think it's, it's absolutely true and it's something that I also recommend to my clients as well. So I'm, I'm really glad that you brought that up.

It's important to have the depth of conversation to help so the people aren't compartmentalizing, perimenopause and their symptoms that it's not just about hot flashes.

Havva: That is generally how it's packaged. 

Bree: I know, I know. I mean, I haven't really had a hot flash yet, I don't think. And my periods are still normal. I mean, they're heavier than they were, so that's a shift. but it's, I have no doubt. Like, I can feel that there's a shift happening, you know, but it doesn't feel, it actually feels good.

Like for me it feels like -- I really think of-- Honestly, I see it as an opportunity to redo puberty. It's like there's a chance to appreciate and bear witness to a body that shifting into a different phase of life from a perspective of love of radical love, 

Radical self-love. Thank you, Sonya Renee Taylor. And, an agency, whereas I did not feel that when I was going through puberty, 

Havva: Any change is the opportunity. You know, it gives you an opportunity to change more than just like what has to happen anyway. 

Bree: Yeah, yeah. Yeah. Well, thank you. I always love talking to you. I think that your perspective and voice will be really meaningful to a lot of people, 

Havva: Well, thank you so much for the opportunity and if it helps people, then that's the icing on the cake.

Bree: Keep playing! Keep playing with those kittens.

Havva: Will do, I'm going to go let him back into the room now, outside the door. 

Bree: Here are my key takeaways from the conversation with Havva. Number one, you shouldn't have to suffer. Just because we're told that pain is normal doesn't mean we have to bear it. Number two, listen to your body and your emotions. This is an opportunity to tune into your deepest needs. Pain or discomfort are coming from somewhere and it should be recognized and acknowledged not dismissed. Number three. Make room for more play in your life. It is worth the effort for your health and your wellbeing to cultivate joy.