What Dr. Haver's protocol illustrates isn't a checklist to replicate. It's a philosophy.
Where Are You in Your Menopause Journey?
Take Our QuizOne of the most common questions Dr. Mary Claire Haver gets is simple: What do you actually take?
And honestly, it makes sense. When you're drowning in conflicting information, when one doctor says hormones are dangerous and another says they're essential, you want to know what someone who actually understands the science does for herself.
In a recent episode of unPAUSED, Dr. Haver walked through every hormone formulation she uses, built around her own labs, risk factors, and goals. She provides an honest explanation for why more isn't always excessive when everything has a purpose.
The point isn't to hand you her protocol to copy. It's to show you what a thoughtful, personalized, evidence-based menopause plan can look like so you can walk into your next appointment knowing exactly what questions to ask, and get the support you deserve.
Seven Ways She Replaces Her Hormones
Yes, seven. Dr. Haver is the first to admit it sounds excessive, but every single one is there for a reason. She is quick to point out that even as a seasoned, board-certified OBGYN and certified menopause practitioner, she works closely with her own clinician to manage her protocol.
Transdermal estradiol patch. Her primary source of systemic estrogen is a generic estradiol patch, applied twice a week. She chose this formulation specifically because it delivers a continuous, steady-state dose, bypasses the liver entirely (which matters for anyone with a history of clotting disorders), and is affordable.
A small dose of oral estradiol at night. Dr. Haver’s symptoms were controlled on the patch alone, but her serum levels told a different story. After reading data out of Dr. Louise Newson's clinic showing roughly 20% of women absorb transdermal estrogen poorly, she checked her own levels and found they weren't hitting bone-protective thresholds. A small dose of oral estradiol at night closed that gap and, as a bonus, brought her cholesterol back into normal range. She doesn't recommend this combination to everyone. This is a decision rooted in her specific labs and goals.
Oral micronized progesterone. If she has one thing she will never miss, it's this. Oral micronized progesterone converts to allopregnanolone in the body, which crosses the blood-brain barrier and binds to GABA receptors, producing calm and sedation resulting in improved sleep. For anyone with a uterus using estrogen, some form of progestogen is mandatory to protect the uterine lining. For those without a uterus, oral micronized progesterone is still worth considering for its other benefits. For the roughly 10 percent of women who don't tolerate it orally, vaginal administration is an option, as is the Mirena IUD or the newer combination medication Duavee, which pairs conjugated estrogens with a SERM called bazedoxifene.
Testosterone gel. At this time, the United States has no FDA-approved testosterone product for women, so Dr. Haver uses a small amount of men's AndroGel off-label. She started it not to improve libido (though that has been an added bonus) but because research shows women in the highest quartile of natural testosterone levels tend to have better bone density, more muscle, and less frailty. She monitors her levels carefully and cautions strongly against the pellet approach, which she frequently sees delivering supraphysiologic doses to women far outside normal female ranges.
Vaginal estrogen cream. A tube of generic vaginal estradiol cream should cost no more than $15. Severe GSM (genitourinary syndrome of menopause) affects up to 84% of postmenopausal women and remains the most undertreated consequence of estrogen loss. Vaginal estrogen used preventatively can cut urinary tract infections in postmenopausal women by 50%, and with them, the risk of urosepsis. She uses the cream twice a week, applying it internally and to the external vulvar tissue.
Topical estriol face cream. Dr. Haver uses this for purely cosmetic purposes. She applies this every morning under her makeup to address the skin thinning that comes with estrogen loss. Unlike alcohol-based vaginal creams, which can be drying on facial skin, this sits in a moisturizing base, which is gentler on the skin.
DHEA for the vestibule. The area around the vaginal opening has androgen receptors, not just estrogen receptors, and DHEA converts locally to both estradiol and testosterone. Dr. Haver uses an over-the-counter DHEA product* formulated for vulvar application, chosen for its texture and added vitamin D. The prescription version, Presterone, is also available but carries no generic and can be expensive.
The Final Piece: What Dr. Haver Takes for Her Hair
Oral minoxidil, at 2.5mg taken nightly (half of a generic 5mg tablet), costs about $5 for a three-month supply and works by prolonging the growth phase of the hair cycle while dilating the blood vessels that feed each follicle. After years of topical minoxidil getting tangled up in her hair-coloring schedule, switching to oral was a simple fix that has worked well for her.
The Takeaway
What Dr. Haver's protocol illustrates isn't a checklist to replicate. It's a philosophy. Check your levels. Know your absorption. Understand what each thing is doing and why. Symptom control and disease protection may require different thresholds, and what works beautifully for one woman may be unnecessary or even counterproductive for another.
If you need a place to get started, download the free Lab Test Checklist and the Menopause Empowerment Guide, both created to provide you with the tools you need to advocate for yourself and the care you deserve.
Remember you’re not broken, and you're not crazy. You are in a biological transition for the rest of your life, and it deserves a biological response. Menopause is inevitable. Suffering is not.
Listen to the full episode of unPAUSED here.
*In development by Dr. Kelly Casperson. If interested in learning more, join her waitlist here. Dr. Mary Claire Haver, The ‘Pause Wellness Clinic, and The ‘Pause Life have no affiliation with Dr. Kelly Casperon or Haven Health.
