IIf you’re a woman born in the 1970s who’s Googled “menopause” on an iPhone, you probably know who Mary Claire Haver is. Since the doctor transitioned from focusing on her Houston gynecology practice to menopause care in 2021, the fast-talking Texan has been flooding social media with advice on dealing with the ills of middle age.
With four million followers across a handful of platforms, she’s tackled menopause from seemingly every angle, including supplements, sleep, diet, exercise (she went through a weighted vest phase) and of course, hormone replacement therapy, commonly called HRT – although Haver prefers ‘MHT’ says (hormone therapy in menopause).
“I wanted to do comprehensive menopause care, with nutrition and everything,” she said. “So I took my girlfriends out to dinner and thought, do you think this will work? Would you like to come see me?” The answer was a resounding yes.
Some doctors, especially in the US, are reluctant to prescribe hormones for patients in perimenopause, the approximately ten-year phase before menstruation ends for good. The most common symptoms are brain fog, weight gain and insomnia, and a program of estrogen, progesterone and sometimes testosterone can help offset these. But Haver is a walking encyclopedia about the preventive benefits of MHT. She says hormones – usually taken orally or through a transdermal patch – can protect our hearts and help prevent osteoporosis and thinning hair, which are often associated with menopause.
Her latest book, The new menopause, is a horribly fascinating text. One section, an A-to-Z guide to the many side effects of hormonal changes, is a whopping 101 pages long. Haver spoke to the Guardian about the mental and physical side effects of perimenopause and menopause, and why so many of her medical colleagues tell their female patients that “it’s all in your head.”
I have never heard “Yes!” written. so often in the margins of a book. And I have you to thank for my new knowledge of ‘armpit fat’”.
It’s just part of a cascade of things. Many of the menopause symptoms covered in the book were shared (with) me by my social media followers. When 10,000 people ask you about a frozen shoulder, tinnitus or dizziness, you listen. And the more I would dig, the more I would find someone who had found a link between patients who are on hormone replacement therapy and have a lower incidence of those things. No one is talking about this and connecting the dots.
What do you think a world in which all men go through menopause would look like?
Unfortunately, drugs are made for men. I don’t want to say there was an ultimate plan to subjugate women in the medical field, but that was the standard, right? And anything that doesn’t happen to a man is abnormal, right? This whole mentality of how (women) are little men with breasts and uteruses has driven medical science research decisions forever.
Women live so long, but 25% of our lives are in poorer health than our male counterparts. So we live a terrible, painful and very sick life. We want to die like men, but that’s not what happens. I just want to drive my truck and have a heart attack one day, you know. Why do we have to lie in bed with dementia and a broken hip? That is the path we follow.
HRT seems to be so much more popular with my friends in the UK than with my friends in the US.
Things aren’t perfect in Britain, but we are way behind Britain. The recognition and treatment of menopause there is about double that in the US.
How did you end up becoming a social media phenomenon?
I was playing around on Facebook when I was promoting (her previous book) The Galveston Diet, which is about nutrition and menopause. It went quite well. But then it was Covid, and I was home with the kids, who were teenagers at the time. They said, Mom, you have to do this TikTok thing. I thought, ‘Dancing on social media? That’s ridiculous.” And then they showed me other doctors dancing and teaching. I thought, well, I can do that. I made my first video, went to bed, woke up and had 10,000 views.
But you’re not dancing in the videos I see.
I started dancing and pointing (at lyrics), and then I realized people wanted to hear me talk, not dance. I got really good at making short 30 second pieces about important information about menopause. I read all the responses in the comments, and it just grew and grew from there.
So your followers lead the dialogue.
Ten thousand women don’t lie to me. They’re not making this up. I try to provide people with information so they can stand up for themselves. I can’t be everyone’s doctor. I’m just a girl in Texas. But I can teach you how to talk to your doctor and help you figure out what to say.
Why is HRT still so controversial? Many doctors won’t consider it. There have been two people who told me to start peddling my papers.
This is what I call the old menopause versus the new menopause. With the old menopause, it’s the same old researchers just rattling off their tired data. They’re all PhDs and they sit in labs, never seeing patients and just collecting data.
I’m like, I’m not going to let you hurt women. I’m ready. I’m going to use my power to tell you no, and we’re not going to stand for this. We continue to give (female) hormones.
In your book you outline the many benefits of hormone therapy, but what are the disadvantages?
The biggest pain in the butt is unplanned bleeding. You get a strange spot. It’s so annoying. If you show this habit, we need to change doses. Your breasts may become tender, or you may experience larger headaches that can trigger migraines. There is an increased risk of blood clots if you take oral estrogen. But the (alleged) risk of breast cancer with estrogen alone does not exist.
There is an increased risk of stroke. So in the case of people with a family history of stroke, we have a conversation about other risk factors for stroke and how to limit them.
You get into cars, you get into planes, we all do things that are risky. Some people drink alcohol. But it’s ridiculous to let breast cancer risk dictate your entire health decision.
Right, in your book you say that the risk of breast cancer associated with taking hormones is exaggerated, and people think it’s 75% higher, but it’s actually about 0.04%.
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There is a relative versus an absolute risk. And we weaponize these guidelines against women, and we weaponize statistics against women and don’t allow them to make an informed choice. You may not choose to use hormone therapy, and I respect that. It’s your body. But you deserve to know what the risks and benefits are.
You also talk a lot about lifestyle choices, as well as nutrition and exercise. What is your best tip?
You’re probably not eating enough protein. Eat more protein and fiber. And if you want to exercise, don’t just do cardio. We have to lift weights. We’ve spent our lives pursuing “fitness,” and we’ve probably undermined our muscle and bone strength.
You’ve posted a lot on TikTok about your weighted vest.
I wear it all the time. I do the dishes with it at home. I have a walking desk and that’s what I set it up for. It’s like a hack. It’s easy.
What is the first sign of perimenopause?
Well, perimenopause is when you’re running low on eggs. The system that makes you ovulate every month starts to break down. The brain has to work harder to talk to the pituitary gland, which sends more hormones to the ovaries and the whole thing goes haywire. You are in hormonal chaos. And we can put a band-aid on that. I can’t reverse your menopause, but we can calm things down by giving you a little estrogen in the background to help you get through the big dips.
Is there something that the treatments you often prescribe cannot help?
We are still getting older. We are not going to stop aging, but we are seeing an acceleration of disease states as we go through menopause, such as insulin resistance and diabetes. We lose 30% of our collagen and estrogen (helps prevent this). But once you develop those wrinkles, they probably won’t go away, and once you develop heart disease, that won’t be reversed. It is the time when your body runs out of estrogen and the problem starts.
How do you see people’s attitudes changing?
I think the boomers are angry. They’re a bit out of the realm of possibility (to start with HRT). So they are furious. They say, “Why didn’t we know?” They watch their mothers fall and break their bones and go through these long periods of decline, and they say, “Oh, my God, is it too late for me?”
I can’t help but think that the next wave of doctors will be better educated and open to therapies.
I think menopause should be optional. I want to age like a man who is not in menopause. A typical man’s testosterone declines by about 1% per year until death. The latest research is really looking at extending the life of the ovary. For me it’s too late, but (people are looking at it) to intervene at a younger age, either by removing an ovary, storing it for a while and replacing it at a certain age, or by taking certain medications that slow down the aging process. . Our ovaries age twice as fast as any other organ in our body.
Unfortunately, we’re still a decade or two away from the time when you can confidently walk into your doctor’s office and have an informed conversation about your menopause journey. We do not train our healthcare providers. So it is up to us to educate ourselves.
I have heard that Estradiol, the vaginal cream that many women get, is the best for skin care. Apparently people use it on their faces to look younger.
Absolute. There were studies that looked at using the 0.1% Estradiol and the 0.03% on the face and they found no systemic absorption. They checked the blood values. There is no danger of it entering your bloodstream. It stays in the skin and they saw improved collagen and elasticity in the skin. I use it. I tell my patients: just take a little bit. Mix it with your moisturizer and apply it around your eyes, where the skin is thin.
You are a rock star on social media. Do you have any advice for people looking to break out on that front?
I talk every morning without makeup in my pajamas and with a cup of coffee. And now that I’m (on a book tour and) doing all these great events, I apologize to the audience, like: do you recognize me? I had Botox for this. I had my hair colored. I have fake nails.