In this solo episode of unPAUSED, Dr. Mary Claire Haver answers one of the most asked questions she receives: what hormones do you actually take, and why? Rather than a general overview of menopause hormone therapy, this is a fully transparent, clinically grounded walk through her personal protocol, including every formulation she uses, why she chose it, and what the FDA-approved alternatives are for women whose needs or circumstances differ.

Dr. Haver opens with systemic estrogen, explaining why she uses a transdermal patch as her primary delivery method, why she added a small dose of oral estradiol for bone protection after finding her serum levels were not reaching the threshold needed to preserve bone density, and why she believes routine estradiol level testing should become standard of care even though current guidelines do not yet reflect the latest absorption data. She walks through the key FDA-approved transdermal and oral estrogen options, including patches, gels, sprays, and oral formulations, covering the differences in delivery, cost, clotting risk, and SHBG implications.

On progesterone, she explains why she takes oral micronized progesterone every night without fail, how it converts to allopregnanolone and binds to the GABA receptor to support deep sleep, and what the alternatives are for women who cannot tolerate it, including vaginal administration, the Combi Patch, progestin IUDs, and Duavee.

She covers testosterone, including why she started it for muscle and bone preservation rather than libido, how she doses and applies the men's formulation off-label, what monitoring looks like, and why she is cautious about pellets. She also walks through the main vaginal and vulvar options for GSM, including estrogen cream, tablets, rings, suppositories, DHEA, and topical estriol for the face, explaining why she considers vaginal estrogen one of the most undertreated and underappreciated tools in menopause care.

The episode closes with a full supplement review covering omega-3s, vitamin D, vitamin K, methylated B vitamins, CoQ10, genistein, collagen, creatine, fiber, magnesium L-threonate, and her sleep supplement formulation, and ends with a discussion of oral minoxidil for hair loss, including dose, cost, and why she switched from topical.

Guest links:

• The 'Pause Wellness
  
• The ‘Pause Life
  
• Dr. Mary Claire Haver (Instagram)
  
• Dr. Mary Claire Haver (YouTube)
• The Menopause Empowerment Guide 

Books:

• “The New Perimenopause,” by Dr. Mary Claire Haver
  
• “The New Menopause,” by Dr. Mary Claire Haver

Articles:

• Hormone therapy and venous thromboembolism among postmenopausal women: impact of the route of estrogen administration and progestogens: the ESTHER study (Circulation)
  
• The Kronos Early Estrogen Prevention Study (KEEPS): what have we learned? (Menopause)
  
• The range and variation in serum estradiol concentration in perimenopausal and postmenopausal women treated with transdermal estradiol in a real-world setting: a cross-sectional study (Menopause)
  
• Estetrol Combined to Progestogen for Menopause or Contraception Indication Is Neutral on Breast Cancer (Cancers)
  
• Oral micronized progesterone for perimenopausal night sweats and hot flushes a Phase III Canada-wide randomized placebo-controlled 4 month trial 9 (Scientific Reports volume)
  
• The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society (Menopause)
  
• Efficacy of vaginal estrogen for recurrent urinary tract infection prevention in hypoestrogenic women (The American Journal of Obstetrics & Gynecology)
  
• Low-dose paroxetine 7.5 mg for menopausal vasomotor symptoms: two randomized controlled trials (Menopause)
  
• The effect of synthetic genistein on menopause symptom management in healthy postmenopausal women: A multi-center, randomized, placebo-controlled study (Maturitas)
  
• Genistein as Potential Therapeutic Candidate for Menopausal Symptoms and Other Related Diseases (Molecules)
  
• Creatine Supplementation in Women’s Health: A Lifespan Perspective (Nutrients)
  
• Investigating the effect of magnesium supplement in patients with major depressive disorder under selective serotonin reuptake inhibitor treatment (Journal of Family Medicine and Primary Care)

Other Resources:

• ISSWSH