Millions of women have turned to Dr. Mary Claire Haver for her clear-eyed, science-backed advice about navigating menopause. She’s written a best-selling book designed to help women understand what’s happening to their bodies during this transition and how they can remain healthy and strong through midlife.
Recently, she asked her followers to send in their burning questions about “the change.” During this live Q&A, Dr. Haver answered everything from how menopause affects cholesterol to whether you can safely use HRT and GLP-1s together to what products she personally uses for hormone replacement, and much more. Watch the full conversation or check out some of the highlights below.
When are you done with menopause?
Dr. Haver: Menopause is one day in your life. It’s when you hit the one-year mark after your final period. Everything after that is post-menopause, and your body will be affected in some way by that loss of estrogen. We have estrogen receptors in every single organ system of our body and those organs are being chronically affected by that deficit.
Everything before that one day is pre- or perimenopause. So you’re never really done with the symptoms. The hot flashes may go away in four, seven, or ten years. But do not define menopause symptoms as simply being the presence or absence of a hot flash — the effects are much more profound than that.
Why am I experiencing body aches?
There is something called the musculoskeletal syndrome of menopause, which is a new diagnosis. Our tendons, muscles, and joints have estrogen and progesterone receptors. Once we go through menopause, we have a more rapid progression toward arthritis. For 20 percent of patients, it’s their most severe symptom of menopause.
Hormone therapy does appear to be preventive for this. Women on HRT tend to have less frozen shoulder and musculoskeletal pain. It’s not a silver bullet, and we do talk in The New Menopause about some other strategies to alleviate some of those issues.
My doctor says my optimal testosterone level should be 400. What are your thoughts?
A normal, healthy female at age 30 — when your natural testosterone levels are at their peak — is between 40 and 70. Anyone who’s dosing you routinely over 100 doesn’t understand women’s endocrinology.
I have high cholesterol, should I go off hormone therapy?
Women on HRT have lower cholesterol levels by an average of 12 percent. Your doctor is misguided if they’re telling you you have to get off your hormone therapy if you have high cholesterol. Women can expect to have a 19 percent increase of their LDL cholesterol across their menopause transition. For many of you, it will be more than that — like it was for me. That would have been nice to know.
There’s a study now that’s looking at a particle called small dense LDL (sdLDL) and using that as a marker for perimenopause, because its levels rise — not proportionate with age but with the menopause transition.
My blood sugar seems out of control since I started menopause. What’s going on?
Insulin resistance increases with menopause, and your risk of developing metabolic syndrome rises twofold to threefold. So if you have a twin who went through menopause naturally at 55 while you had your ovaries removed at 45, you would have higher blood pressure, cholesterol, higher insulin resistance, and about three times the amount of visceral fat. That’s even if you ate, drank, and exercised in the exact same way.
Are HRT and Tirzepatide OK to use together?
We prescribe that quite a bit in our clinic if our patients are good candidates for both. Up to 20 percent of our patients are probably on a combination of HRT and GLP-1.
What is your HRT regimen?
I replace my hormones in several ways. I use oral micronized progesterone, which I take at night. I use testosterone in the form of AndroGel. I apply a pea-sized amount on my forearm and rub it in. I have an Estradiol patch, which I wear on my lower abdomen — right above my C-section scar.
I also use a prescription face cream called estriol that I get from Alloy health. And finally, I use a vaginal estrogen cream. I use it two to three times a week, applying it around the labia and inside the vagina, to keep my genitourinary system healthy.
Does birth control work for menopause symptoms? I’m 54 years old.
So the medication that’s in a birth control pill is an estrogen and progesterone, and typically they’re synthetic. It will work and control your symptoms, at least on the days you’re taking it. You may notice symptoms on the placebo days. But at 54, you may not need contraception and this may be overkill. I prefer my patients to have body-identical forms for safety.
This conversation has been edited for length and clarity.
