‘Menopause should be optional’: the doctor demystifying care for millions on TikTok | Well actually

IIf you’re a woman born in the 1970s who Googled “menopause” on an iPhone, you probably know who Mary Claire Haver is. Since the doctor switched from his Houston-area OB/GYN focus to menopausal care in 2021, the fast-talking Texan has been flooding social media with tips for dealing with the ailments of middle-aged.

With a following of 4 million across a handful of platforms, she’s nailed it the menopause from seemingly every angle, including supplements, sleep, nutrition, exercise (she’s going through a straightjacket phase) and, of course, hormone replacement therapy, commonly called HRT—though Havre prefers to say “MHT” (menopausal hormone therapy). .

“I wanted to do holistic menopause care with nutrition and everything,” she said. “So I took my girlfriends out to dinner and I was like, ‘Do you think this is going to work?’ Would you come see me?” The answer was a resounding yes.

Some doctors, especially in the US, are unwilling to prescribe hormones in perimenopausal patients, the decade-long or longer premenstrual phase ends forever. The most prominent 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 on the preventive benefits of MHT. She says the hormones — usually taken by mouth or via a transdermal patch — can protect our hearts and help prevent osteoporosis and thinning hair, which are commonly associated with menopause.

Her latest book, The new menopause, is a terrifyingly engaging text. One section, an A to Z guide to the many side effects of hormonal changes, is no less than 101 pages long. Havre spoke to the Guardian about the mental and physical side effects of perimenopause and menopause, and why so many of her fellow doctors tell their patients that “it’s all in your head”.

I never wrote “Bay!” in the field of a book so many times. And I have you to thank for my newfound knowledge of “armpit fat”.

It’s just part of a cascade of things. A lot [the menopause symptoms covered in the book] were [shared with] me from my social media followers. When 10,000 people ask you about a frozen shoulder, ringing in the ears, or vertigo, you listen. And the more I dug, the more I would find someone out there who had found a connection between patients who were on [hormone replacement therapy] and have a lower incidence of these things. No one is talking about it or connecting the dots.

What do you think a world where all men go through menopause would look like?

Unfortunately, medicine was created for men. I don’t want to say that there was this ultimate plan to subjugate women in the medical profession, but they were by default, weren’t they? And anything that doesn’t happen to a man is abnormal, right? All this thinking how [women] are little men with breasts and wombs has made medical scientific research decisions forever.

Women live as long, but 25% of our lives are spent in worse health than our male counterparts. So we live a terrible, painful, very painful life. We want to die as men, but it doesn’t happen. 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? This is the way we are going.

HRT seems to be much more popular with my friends in the UK than my friends in the States.

It’s not perfect in the UK, but we’re way behind the UK. Recognition and treatment of menopause there is about twice as high as in the US.

How did you end up becoming a social media phenomenon?

I was playing around a bit on Facebook when I was advertising [her previous book] The Galveston Diet, which is about nutrition and menopause. It was going pretty well. But then it was Covid and I was at home with the kids who were teenagers at the time. They said mom, you should do this TikTok thing. I thought, “You dance on social media? That’s funny.” And then they showed me other doctors who were dancing and teaching. I was like, Well, I can do that. I did my first video, I went to bed, I woke up, and I had 10,000 views.

But you don’t dance in the videos I see.

I started dancing and pointing [at text], and then I realized that people want to hear me talk, not dance. I’ve become very good at making 30-second highlights on 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 are not making this up. I try to arm people with information so they can advocate for themselves. I can’t be everybody’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 will not consider it. I had two people tell me to go sell my papers.

This is what I call the old menopause versus the new menopause. With the old menopause, the same old researchers are just regurgitating their tired data. They are all doctors and sit in labs and never see patients and just collect data.

I tell myself: I won’t let you hurt women. I’m done. I’m going to use my power to tell you guys no, and we won’t stand for that. We will keep on giving [women] hormones.

In your book, you outline the many benefits of hormone therapy, but what are the downsides?

The biggest pain in the ass is unplanned bleeding. You will get this weird smudging. It’s so annoying. If you have this habit, we need to change the doses. Your breasts may become tender or you may get a stronger headache, which can trigger a migraine. There is an increased risk of blood clots if you take oral estrogen. But on [reputed] the risk of breast cancer with estrogen alone does not exist.

There is an increased risk of stroke. So in the case of people who have a family history of stroke, we have a conversation about other risk factors for stroke and how to limit them.

You get in cars, you get in planes, we all do things that are risky. Some people drink alcohol. But letting your entire health decision be driven by breast cancer risk is ridiculous.

True, in your book you say that the risk of breast cancer that comes with taking hormones is exaggerated and people think it’s 75% higher, but it’s actually something like 0.04%.

There is relative versus absolute risk. And we use these guidelines against women, and we use the statistics against women and we don’t allow them to make informed choices. You may not choose to use hormone therapy and I respect that. This is your body. But you deserve to know what the risks and benefits are.

You also talk a lot about lifestyle choices as well as diet and exercise. What is your best advice?

You’re probably not eating enough protein. Eat more protein and fiber. And for exercise, don’t just do cardio. We have to lift weights. We have spent our lives chasing “fitness” and have probably eroded the strength of our muscles and bones.

You’ve posted a lot on TikTok about your weighted vest.

I wear it all the time. I wash the dishes with it at home. I have a walking desk and will put it up for this. It’s like hacking. This is easy.

What is the first sign of perimenopause?

Well, perimenopause is when your eggs run out. The system that would make you ovulate every month starts to break down. The brain has to work harder to communicate with the pituitary gland [gland], which sends more hormones down to the ovaries and everything goes haywire. You are in hormonal chaos. And we can glue it. I can’t reverse your menopause, but we can calm things down by giving you some estrogen in the background to support you for those big dips.

Is there anything the treatments you prescribe can’t help?

We’re still getting old. We won’t stop aging, but we see an acceleration of disease states as we go through the transition [of menopause], such as insulin resistance and diabetes. We lose 30% of our collagen and estrogen [helps to prevent this]. But once you develop those wrinkles, you probably won’t get rid of them, and once you get heart disease, it won’t reverse that. This is when your body is away from estrogen when the problem starts.

How do you see people’s attitudes changing?

I think the boomers are angry. They’re kind of outside the window of opportunity [to start 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 more educated and open to therapies.

I think menopause is optional. I want to grow old like a non-menopausal man. The typical man’s testosterone declines by about 1% per year until death. The latest research is indeed looking at extending the life of the ovary. It’s too late for me, but [people are looking at] intervention at a younger age, or by removing an ovary and storing it for a while and putting it back at a certain age, or certain drugs that will slow down the aging process. Our ovaries age twice as fast as any other organ in our body.

Unfortunately, we’re a decade or two away from being able to confidently walk into your primary care physician’s office and have an informed conversation about your menopause journey. We do not educate our healthcare providers. So the onus is on us to educate ourselves.

I’ve heard that Estradiol, the vaginal cream given to many women is the best thing for skin care. Apparently people use it on their face to look younger.

Absolutely. There have been studies looking at the use of 0.1% estradiol and 0.03% on the face and found no systemic absorption. They checked the blood levels – there is no danger of it getting into the blood. It stays in the skin and they see improved collagen and skin elasticity. I use it. I tell my patients, take some. Mix it with your moisturizer and apply it around the eyes where the skin is thin.

You are a social media rock star. Do you have any advice for people looking to break through on this front?

Every morning I speak without makeup in my pajamas and with a cup of coffee. And now I am [on book tour and] I do all these fancy events, I apologize to the audience, like: do you recognize me? I had botox for it all. I dyed my hair. I have artificial nails.