Menopause Masterclass: My Menopause Toolkit – HRT and more

26:45Dr. Mary Claire Haver:Basically, it is where you have low desire, where you love your partner, you used to want to do it, it was something you look forward to, It was fun. You enjoyed it. But now you don't. And then you miss it. So we do need to normalize the conversation around what if you just don't want to ever do it again and you don't care? That's fine. That's fine. That's not who testosterone is for. It is not to suddenly create something that you never had before you don't want to get. So it is a very specific set of patients. But again, I've talked about this on the podcast. I started it off label because I had read that women who have naturally the highest quartile of testosterone levels, remember, we all have different testosterone levels, have better bone and muscle strength, less frailty, less sarcopenia.

27:31Dr. Mary Claire Haver:And I was like, huh, what if I use this and physiologic ranges for a female and then kept my workouts going? Maybe this would help me hang on to my muscle, maybe build a little more, a little faster. So I started it for that. But I have to say, I did not qualify for HSDD, but I have noticed an uptick in the desire area and I like it. And I think I would miss it if we took the testosterone away. So that is my end of one, full disclosure. I did notice some improvements in my energy, I think. And we check levels. Side effects of excess testosterone in women are acne, hair growth in places you don't want it, and losing hair in places you do want it, usually in a temporal area.

28:10Dr. Mary Claire Haver:If it's really high, we can see things like clitoromegaly, which is not reversible. We can see voice changers, which are not reversible. Dosing matters. Monitoring matters. and this is not something to DIY at all. So again, can you access it? So there's male approved gels that are off-label, androgel, T-STEM, and there's something called vulgolexo. I haven't used that one, but our clinic has used androgel and T-STEM. For the T-STEM, you want to get the tubes and not the packets. The packets, once you open them, the alcohol will start to evaporate and you basically have to use it all that one time.

28:45Dr. Mary Claire Haver:You can't like hold it and save it for later and those packets are dosed for men. So you want to make sure you get the tube so that you can use multiple doses in the tubes. This cost me about$55 with a coupon and lasts about six months. So very, very, very affordable. Those of you who are paying hundreds of dollars every quarter for your pellets, I want you to ask your clinician, is there another way? You don't have to spend that much money to get excellent, excellent FDA approved, monitored, great testosterone. I have compounded testosterone cream in the past. We didn't have a good supplier for the androgel.

29:23Dr. Mary Claire Haver:We worked that out. So we were compounding with a local pharmacy for our patients. It works pretty well. It's typically at 0.5 to a 2 % concentration. That allows for more precise female dosing. And the downside is that those products aren't traditionally FDA regulated. So the quality really depends on the pharmacy. You can't expect to have the same quality coming out of each individual pharmacy because they don't have the same oversight. So subcutaneous pellets are very popular. I know many of you listening or watching are using the pellets and might be happy with them. Some clinicians do use these.

29:56Dr. Mary Claire Haver:I just I'm very cautious about pellets because once they're in, you can't undo them. And there's one particular company that never made a female pellet. They just take the male pellets at lower doses and they put them in the women. And the women are walking into my clinic with levels in the hundreds, which are far, far, far above a physiologic range. Now we're talking about performance enhancement. Now we're not talking about replacing a female physiologic dose. And if you're into, you know, performance enhancement, that's up to you. You need to be honest about why you're doing this. That is not what we do in our clinics here.

30:29Dr. Mary Claire Haver:We're here for menopause care. We're here for HSTD and to just give our patients their best life. If your clinician is curious and unfamiliar with it, ISHWISH, which is the International National Society for the Study of Women's Sexual Wellness, health and wellness, has an awesome website. And they have so many resources to help clinicians learn how to properly prescribe, how to test, and how to dose testosterone for their patients.

31:03Dr. Mary Claire Haver:Now we're going to talk, we're going to skip to vaginal and vulvar health. So let me move these over here.

31:11Dr. Mary Claire Haver:topical vaginal estradiol. So this is plain generic vaginal estradiol. This tube probably should cost you no more than$15. Okay, you may have to hustle and go find a coupon or go through Mark Cuban or Walmart or whatever, but this is cheap. You should not be paying anything more than about$15 for your tube. So I really want to talk about this section because of GSM. We've had some incredible updated guidelines in the last year that have been adopted from every major organization that has anything to do with the female pelvis. GSM affects, severe GSM, severe, affects up to 84 % of postmenopausal women and is still remains right now the most undertreated, underdiagnosed, underdiscussed consequence of estrogen loss.

31:58100 % of us will see changes

32:01Dr. Mary Claire Haver:in our genital urinary system after menopause if we're not treated. And in my clinic, we have very aggressive conversations about using this prophylactically so that you never develop GSM. Why? Because this little tube will save lives. We can decrease 50 % of urinary tract infections in postmenopausal women by using this prophylactically. and when we do that we will cut down on 50 percent of urosepsis and death from urosepsis so untreated gsm does kill women at very very high levels especially women in nursing homes especially women with limited movement who don't have great hygiene because you know of arthritis or bed bound or just chronic incontinence so many women are suffering needlessly and not having access to this very simple treatment and tool of vaginal estrogen.

32:55Dr. Mary Claire Haver:Now, I choose the vaginal estrogen cream because of cost. It is messy. It's not for everyone. We have many options and we'll go through them. But, you know, keeping it in the$15 range makes it accessible to so many more women. Other things that happen in the general urinary system, the tissues become thinner, drier, less elastic, more fragile, more prone to irritation, tearing, and infection. Your pH changes, the microbiome shifts, and the urinary symptoms develop. This is not cosmetic. This is tissue health, and it really, really, really deserves treatment. So vaginal estrogen cream. So we have the non-generic form is called Estrase.

33:33Dr. Mary Claire Haver:There's also still Premarin cream available. Premarin cream is great. There's just no generic, and it tends to be one of the most expensive options. We typically use this twice a week. It comes with an applicator. I just tell my patients, put it from mid-knuckle here to the tip of your finger and get up in there and roto-rooter it about halfway up into the vagina. Then you take a little bit more and you're going to put it on the clitoris and go down both sides of the labia minora. That's going to hit all of the hot spots that you need. There are vaginal tablets available. Vagifem and Uvifem are 10 micrograms.

34:07Dr. Mary Claire Haver:They come with a small applicator. Now, these creams are alcohol-based. They can cause irritation. You might have a reaction to them. So the pills can be really, really helpful. It's just the applicator is like this little pencil and you have to put the tip of arthritis or you don't see very well. It can be hard. You can like try to put this tiny little pill on the tip of your finger and like wiggle it up into the vagina. You know, so there's pros and cons to all the things. There is a vaginal insert. So Invexi is a suppository that is much easier to insert. It's nice and smooth and it's easy to push into the vagina.

34:40Dr. Mary Claire Haver:It comes in four and 10 microgram dosages and you don't need an applicator for the four microgram dose. However, there's no generic for Invexi. And again, cost can be an issue. My favorite way to replace estrogen down there is with the vaginal ring. Again, super sad we do not have a generic, but God, it lasts for three months. You throw it up in the vagina. It finds a little home up there. It really does not bother you. It's like a tampon placed correctly. You don't feel it. And it is just constantly giving you that continuous supply of estrogen in the vagina for three months and you don't have to worry about it.

35:14Dr. Mary Claire Haver:You just set an alarm on your phone to go take out the old ring and put in the new one. You can leave it in for intercourse. I tell my patients to leave it in, see if he notices. You know, it might be kind of fun. I don't know. But all of these options have been studied and they all help. So I do want to talk about DHEA. So DHEA, we have an FDA approved option for the vagina called Prasterone, which is fancy name for DHEA. So DHEA also can be used for the vestibule. So for those of you who are having pain around the opening, pain around the vaginal opening, that is not responding. When you apply DHEA there, and I have this as an over-the-counter version that I also use, DHEA will in the cells convert to estradiol and testosterone, both.

35:58Dr. Mary Claire Haver:There are androgen receptors in the vestibule, in the vulva. And so you're getting both estrogen and testosterone. So the prasterone is the suppositories that is DHEA that you put in the vagina. They melt, they work up there, but then the medication kind of dribs out and you get it. You know, it makes its way to the vulva and to the vestibule around the opening. And so patients love it. It's very, very safe. Again, no generic, very expensive. This is a lower dose DHEA from my friend Kelly Casperson for the vulva. I really like the texture of it. And I just like having that little bit of extra protection.

36:35Dr. Mary Claire Haver:And it also has vitamin D. So it's a very nice oil-based lubricant and moisturizer. And I'm a huge fan of it. So I don't use Prosterone because I have this. And my vaginal estrogen of which I use as well. Lots of questions. I know you guys are asking, what is this last guy? this is topical estrogen for my face. So you actually can take this vaginal estrogen cream and put it on your face. Okay. It's recommended to do a pea-sized amount and you put it, especially on your eyes where the tissues is really thin, and then you rub it and you put moisturizer on top. The problem with this is again, alcohol-based creams can be drying for the skin and not for everyone.

37:16Dr. Mary Claire Haver:So I have chosen to do this cream that has estriol, which is a cousin of Estradiol and it's a 0.3%. It has been studied showing efficacy and safety. You do not have systemic absorption. The nice thing about topical, anyone can use it. Anyone can use vaginal. Anyone can use it on the skin. And this I apply every morning and it is in a, instead of an alcohol base, it's in a moisturizing base. So it's basically taking the Estradiol, throw it in a moisturizer and it's just easier for me to apply. My skin doesn't get dry. I could just put makeup on if I'm wearing makeup that day. It's not a big deal.

37:53Dr. Mary Claire Haver:So these are the seven ways. It's not something I recommend to every patient. This is purely cosmetic. It can be pricey depending on where you get it from. And so, but I just wanted to throw it out there. So these are the seven ways that I replace my hormones. So, but we do have non-hormonal FDA approved alternatives, but we really have to take it symptom by symptom. But I did want to cover some of the big ones of these so that those of you who do have contraindications to certain hormones know what your options are. And then after this, we're going to get to supplements. So we have Vioza or Fezzoliniac.

38:33Dr. Mary Claire Haver:So Fezzoliniac is a very new medication. It just came out in the last year or two. These are medications that bind to the thermoregulatory centers in the brain. It's the neurokinin-3 receptor, which is in our thermoregulatory center. It binds and stabilizes it. So hot flashes in most patients will improve. It specifically is targeting the mechanism where the hot flashes happen. And so without having to, you know, have estrogen in any other part of your body, if you have been advised that that is not in your best interest. So it's great for hot flashes. So if you're an active breast cancer patient who's been told you're not a candidate for estrogen, these medications can be really helpful.

39:13Dr. Mary Claire Haver:A new one has come on the market from Bayer. I cannot remember the name of it of the day, but there's competitors coming out. These are new. We're probably five to six years away from any generics being available. So again, cost can be a huge issue here. The only SSRI is paroxetine. That's the generic name or Brisdale. That has been FDA approved specifically for hot flashes. It's a lower dose version of paroxetine at 7.5 milligrams. It can reduce hot flash frequency by 50 to 65 % in some women, and it's not a hormone. So if you're on tamoxifen, however, and you're having hot flashes because you're on tamoxifen, peroxetine is contraindicated because it does inhibit the enzyme, very long name, enzyme that converts tamoxifen to its active metabolite.

40:00Dr. Mary Claire Haver:That's a really critical drug interaction. So I'm happy to say that the tamoxifen patients can actually take the neurokinin receptor antagonist and can have benefit. But to be honest, hormone therapy is the gold standard. And forever, people were defining menopause treatment as the reduction of hot flashes, nothing else. They weren't talking about your brain fog, your emotional status, your bones, your inflammation levels, your insulin levels. I mean, all of that is affected. And estrogen is the best therapy to stabilize all of these inflection points in our chronic disease process. But if for whatever reason that is taken off the table for you, or if you just choose not to do it, there are options, but we have to take it symptom by symptom.

40:44Dr. Mary Claire Haver:This is like supplement routine. God, it seems like a lot. It is a lot. I understand that. But I'm going to walk through every supplement I take, why I take it, and what it does for me specifically. But I want to repeat, this is based on me. This is my labs, my goals, my risk factors. Supplements should never be a guessing game, and supplements will never replace good nutrition. Most of your nutrition should come from food, whole foods, anti-inflammatory foods, grains, nuts, seeds, legumes, lean proteins. I can't stress this enough. You cannot take a bucket of supplements and expect to have a miracle happen if you are not backing that up with good, high-quality nutrition.

41:27Dr. Mary Claire Haver:Okay, so let's talk about this guy. This is a combination because I'm lazy. So full disclosure, first of all, I own a supplement company called The Paws Nutrition, The Paws Life. And I started talking about menopause under in the frame of nutrition, in the frame of the Galveston diet, in the frame of trying to answer the question of body composition changes and why women were gaining weight. So we came up with a whole nutrition plan that was very successful. We had coaching groups to coach people through all the exercise recommendations and nutrition recommendations. and we were making supplement recommendations.

42:05Dr. Mary Claire Haver:Women tend to not be able to absorb enough vitamin D to stay healthy. Women tend to not be able to get enough fiber in their diet. So I was constantly recommending supplements. All right, have patients come in with buckets and bags of supplements. And I'd be like, what do you take this for? She's like, I don't know, they hated this to me. And I couldn't tell who manufactured it, if there were third-party tests. It's really, really hard out there because of lack of some of the regulations around it. and I thought, can I do this better? I think I can. And I really fought it for a long time because a lot of people don't feel like physicians should sell supplements.

42:43Dr. Mary Claire Haver:It's a bit of a red flag and I felt a little bit about myself, but here I was recommending, here are patients in trying to self-diagnose, self-treat and coming in with buckets and bags of things that made very little sense. And I thought, okay, I can create something that is high quality and third-party tested and put my name on it. I'm going to do it. And so we did. There are lots of good supplement companies out there. There are lots of supplement companies that are sus as hell. Okay, so you want to look for things that have studies. You want to look for things that are third-party tested for purity.

43:19Dr. Mary Claire Haver:And so to make sure they're not contaminated and to make sure that actually what they say is in it, is in it. Super proud that we were able to meet those goals and have really good high-quality supplements on things that were actually studied in women in menopause and not 25-year-old male athlete. So, omega-3, vitamin D, and vitamin K combination. I like to combine things because I'm lazy. And it's easy, easy, easy to combine omega-3 and vitamin D. Like, they're like peanut butter and jelly as far as, like, they sit well together, they don't contaminate each other, there's no reaction. And vitamin K we threw in there for increased absorption.

43:57Dr. Mary Claire Haver:So one caveat, if you're on Coumadin, you should not be taking this because it has vitamin K. All right. So if you're on a blood thinner, turn to your doctor before starting any supplement. This has 4 ,000 international units of vitamin D. It has 1.2, so about 1 ,200 milligrams of EPA and another 800 milligrams of DHA. So those are the omega-3 fatty acids. These are critical. When we check vitamin D levels in our clinic and when you look across the spectrum in the U.S., most women, the majority, well over 50%, in our clinic it's about 80 % of menopausal women, have low vitamin D levels. So there is deficiency levels, which is below 30-ish in women.

44:38Dr. Mary Claire Haver:And then there is optimal, which is somewhere around 60 to 100, where you're not deficient, but you're really optimal firing on all cylinders with nice high vitamin D levels. You can take up to 4 ,000 units of vitamin D a day without needing to be monitored. Okay, now prescription strength vitamin D is about 50 ,000 IUs a week. Okay, so we're giving you 4 ,000 IUs a day with this. I love this. I love it for heart health. I love it for inflammation. And vitamin D is a hormone, and it is critical in dozens and dozens of enzymatic processes in our body. Low vitamin D levels are rampant, and they are linked to weight gain, diabetes, dementia, low sleep, cardiovascular disease, all the things.

45:21Dr. Mary Claire Haver:So if you learn nothing else from this talk today, go get your vitamin D level checked. Know where you are. So when my patients come in who are deficient, we're putting them on the prescription strength first. Okay, we want to give them a loading dose. We're giving them that prescription of that 5 ,000, 50 ,000 IUs a week for about a month. And while on the other days they're not taking that, we're supplementing with this. And then we checked our level at three months to see how they are maintaining. And then once a year, they seem to be maintaining at their annual visit. Love this stuff so much.

45:49Dr. Mary Claire Haver:Okay, so I take this every day. So this is our Mino Multi. Is that really a multivitamin? I wanted to make a multi-use, a multi-layered product because there's so many good studies that looking at women in menopause and coenzyme Q10 in heart health. There is wonderful data on gennistin, which is a phytoestrogen, which is a powerful anti-inflammatory component. It's been studied in bone health in women, in heart health, and in inflammation. And then we know that most of our patients are struggling to get these B vitamins. we see it in when we look at homocysteine levels. So we're checking homocysteine levels in patients and we're seeing a tremendous amount of a very high percentage of women who are struggling with high levels of homocysteine.

46:34Dr. Mary Claire Haver:And it's usually because they're not able to utilize their B12 or folate. And so this has very special B vitamins that are actually methylated for easier use within the body for these patients. And it seems to be working really well. So you've got your thiamine, riboflavin, niacin, B6, folate B12 biotin, and then we have the genistin and then the coenzyme Q10 together. And it's just one pill a day. Welcome back to another MidiPause. I'm Dr. Mary Claire Haver, host of Unpaused. For years, I believe the gaps in women's healthcare came from individual failings, a distracted clinician, a rushed appointment, a misread symptom, a misdiagnosis.

47:20But the longer

47:21Dr. Mary Claire Haver:I practiced, the clearer it became. This is not about one clinician or one hospital. This is about a system built on the male body as the standard and the female body as the outlier. Here we are in 2026 with women across the country demanding more coverage, more information, more data, and the system is starting to respond. Women's health has been historically overlooked, underfunded, and frankly, misunderstood. From delayed diagnoses to limited access to care, the gaps are real, and they have real consequences. We've made progress, but there's still a long way to go. So how do we each play a role in creating change?

48:05Dr. Mary Claire Haver:This is where platforms like MidiHealth come in. Midi focuses on providing personalized, expert care for women navigating midlife health, especially menopause, an area that has been overlooked for far too long. They connect women with clinicians who specialize in these concerns, offering virtual care that is accessible, evidence-based, and grounded in real patient experiences. This includes everything from reproductive care to preventative screenings to mental health support. These are not luxuries. They are essential. When access is limited, it disproportionately affects women in underserved communities, which makes advocacy even more important.

48:48Dr. Mary Claire Haver:Stay informed. Have conversations. Support organizations and platforms like MIDI that are actively working to close those gaps. Vote with women's health in mind. And in your own life, create spaces where women feel heard and supported, whether it's at work, at home, or in your community. Change does not happen overnight, but it does happen when people decide it matters enough to speak up. There's nothing more important than understanding the options available to you in managing the symptoms you're experiencing. And if you want a little extra support, you can check out my menopause empowerment guide in the show notes for additional information and resources.

49:30Dr. Mary Claire Haver:I hope that this information helps you feel more confident and more empowered because you are your best advocate for the health care you need and deserve to achieve your best health. Go to joinmidi.com, join m-i-d-i.com, and connect with one of their clinicians today.

49:52Dr. Mary Claire Haver:If you follow me, you know I make a shake almost every day, or I'll make it and make it last two days. I had one this morning. And so in my shake, I call it the menopause shake, but really anybody can take it. My kids make it. It's a way for me to start hitting my nutritional goals early in the morning. So I break my fast with it. I take it down to the gym and I sip at it for three to four hours until it's done. Or if I make the halfway mark, depending on if we have lunch planned. So in it is Greek yogurt, plain Greek yogurt. Why? For probiotics and for protein. Okay. And then we have, I put our collagen.

50:30Dr. Mary Claire Haver:So our skin and bone collagen right here. We're going to put two scoops in here. It has two separate collagen products. One is called Verisol, which was studied in skin for wrinkles and cellulite appearance. So it's a vanity product. And it was also in it is something called Fortabone. I got super excited about Fortabone when the studies were studied in menopausal women with osteoporosis and osteopenia. And they saw benefit to their bones and they weren't on any other intervention. They followed them for five years, taking this every day. And so I was like, I want this. I want to combine these two collagens together and call it skin and bone.

51:05Dr. Mary Claire Haver:And so here's the product. It's two scoops. I just throw this in the Shake the Unflavored version as well. This is new-ish for us. This is our whey protein product. So it's protein and we threw some creatine in there. It's brand new. I put a scoop of this in it. I like chocolate. We do have vanilla as well. And then when I make my water for the gem, actually back here. I didn't bring any with me, but I like electrolytes, not because I think that they're a miracle or doing much for me. I like salt. And I'll put my salty electrolytes in here with a couple of scoops of creatine. So studies on women are looking extremely good.

51:44Dr. Mary Claire Haver:If you look at Abby Smith Ryan coming out of North Carolina, her research looking at women and strength training and creatine, we can't make as much as we age. It's one of those things. And so it's so important for muscle recovery. Also, it seems to have a lot of good use for brain fog and sleep. And so I put my creatine and my electrolytes and then I stay hydrated throughout the day with this guy. Our creatine comes in a two-month supply and this beautiful guy right here. So do you need all of this? Probably not, but this is just what I take, what I do, and why. I also, in that little shake, throw in a little extra fiber.

52:20Dr. Mary Claire Haver:So one scoop here has eight grams of fiber. This is flavorless. You can throw it in your coffee. You can throw it in water. You can throw it in whatever you want. But I'm able to get pretty consistently 25 to 30-ish grams of fiber in my diet just from food, from mostly from avocados, seeds, nuts, legumes, which are beans. But just gives me that little edge to take it over the top because for cardiovascular protection, for gut health, 25 seems to be pretty good. But for cardiovascular protection, women want to get 35 to 38 grams. So this just gets me over the top. Days I don't have yogurt, okay, for my probiotics.

52:57Dr. Mary Claire Haver:I will take a probiotic as well. There's decent studies done in menopausal women showing in better body composition, showing better gut health, etc. So I do do that. And I took this for a long time. This is magnesium EML 3 and 8. This is a mag that is very good at crossing the blood-brain barrier. It was actually studied in SSRI-resistant depression, and it really did seem to help those patients who were not doing well with severe depression on their anti-depression medication. And so it just has a really great way to cross the blood-brain barrier. So I tend to take this in the day to get my mag levels up and up to my brain.

53:35Dr. Mary Claire Haver:So finally, we have our pause sleep. So sleep disruption is one of the most debilitating symptoms of perimenopause and menopause. And it really compounds everything. Poor sleep worsens insulin resistance. It worsens body composition, increases inflammation, and impairs your cognitive function. Like we have to prioritize sleep. And so many women are being medicated with sedatives to kind of force them to sleep, but they're not getting the good high quality sleep. They're not getting the deep sleep when you're chronically on these medications. So I partnered with a sleep medicine specialist, Dr.

54:13Dr. Mary Claire Haver:Andrea Matsumura, to come up with a product that was evidence-based that would help women specifically their needs in the sleep phase. So if you're having hot flashes and that's waking up from sleep, we need to fix the hot flashes and And that is not what sleep is doing. This is for the woman whose vasomotor symptoms are controlled or she doesn't have them, who is struggling to go to sleep or struggling to stay asleep. So she and I decided to put three key elements in this product. So it is a combination of alpha wave L-theanine. L-theanine is a natural relaxant. It's a natural anti-anxiety medication.

54:52Dr. Mary Claire Haver:So we are relaxing the mind with this. It also has a magnesium product, this glycinate that crosses the blood-brain barrier well that gets into the system and relaxes the body and muscles. And then finally, it has a very, very small dose of a long-acting melatonin. It only has three milligrams. I was overdosing melatonin. I never understood how to use it. And so what melatonin does is reset your circadian rhythm. Circadian rhythm is what controls when you go to bed, when you wake up, when the cortisol levels spike. It's so, so, so important. So relax your body, relax your mind, reset the circadian rhythm.

55:34Dr. Mary Claire Haver:You want to take this an hour or two before you go to bed so that it's all kicked in and kind of working. So around seven, eight o 'clock, I will take my two pills and I'll start reading and winding down for the night in my nighttime routine to go to bed. One last thing I want to talk about is another prescription that I take. I actually take it at night. On my bedside table, I have my sleep supplement, I have my progesterone, I have my oral estradiol, and I have my minoxidil. So vanity product that I use to keep my hair on my head. And I started with topical minoxidil. My perimenopause was fraught with hair loss.

56:13Dr. Mary Claire Haver:I was born with a lot of hair. and so you know how you have your daily allotted hair loss in the shower I was having like postpartum hair loss and it was very very scary so of course I called my dermatology friends and they're like try this try that you know we had blood work done they looked for low iron and all the other things they could be and they're like okay we'll try topical minoxidil and so it's basically generic Rogaine and get the men's strength the five percent extra strength don't worry about the women's you don't need that and that seemed to work really well and I did it for a few years, but it just got messy, right?

56:44Dr. Mary Claire Haver:I was using the alcohol base and it would make my hair kind of sticky. And now that I color my hair to color the grays, the whole like hair map of when to wash my hair, but I got to put the minoxidil in, but I can't have minoxidil in because the color won't stick. Just got to be a lot. And then my derm friends were like, well, just switch to oral. And I was like, oh, okay. So the oral doses, you only need about 2.5 milligrams and they make it in a five. So I just cut this in half and it is$5 for a nine month for a three month supply. It's generic. It's so inexpensive. So in my nighttime, take all my meds routine.

57:18Dr. Mary Claire Haver:I'm just going to crack one of these in half and then take all that before I go to bed. Oral monoxidil works by prolonging the growth phase of the hair cycle. So our hair has a growing phase, a falling out phase and a resting phase. And it also helps to dilate the blood vessels that feed the hair follicle to keep the follicle healthy. So this medication was developed to lower blood pressure, but the doses you take it for blood pressure control are 10 to 40 milligrams. For hair, you only need 2.5. So that's what I take. It seems to be working really well. I rarely miss it. If you're experiencing care loss, an oxidative may not be for you.

57:54Dr. Mary Claire Haver:You need to have your vitamin D level checked. You need to have your ferritin level checked. You need to maybe see a dermatologist, but this is one of the things, and I've done all of that, that works really well for me, and I'm happy to have my hair back. So that's my routine. You might think it's excessive. I like it. It works for me. So my transdermal estradiol patch plus a little bit of oral estradiol at night for bone protection, my oral micronized progesterone at bedtime, my testosterone gel every day, my vaginal estrogen twice a week. So when I put my patch on, I use my vaginal estrogen as well.

58:27Dr. Mary Claire Haver:My daily topical estradiol, my DHEA for the vestibule. And then I have all my potions and powders that I put in shakes. I have my methylated bees, my CoQ10, my biotin with our minimal tea. And then I have my pause sleep with L-theanine, magnesium, and sustained-released melatonin, and then the oral minoxidil for my hair. So yeah, it's a lot, but everything is there for a reason. I was losing my hair. I wasn't sleeping as well as I should be to protect my brain from dementia. And so to protect my stress levels, to protect my cortisol, my body composition, Everything I take is for a reason. I take fiber to lower my risk of diabetes, to help keep my body composition checked, to lower my risk for heart disease.

59:10Dr. Mary Claire Haver:My recommendation is test. Check your levels of nutrients. Check your intracellular magnesium. Check your ferritin. Get your vitamin D levels checked. Know where you are. Track what you eat. Are you getting enough protein? You may not need a protein supplement if you're able to get it all in. Not everybody has to take this. Most of us should be taking creatine. We just can't make enough of it. if you're getting enough fiber in your diet, you don't need a fiber supplement. So know what you're eating, know what you're intaking, know what your blood levels are of important key levels and nutrients, and then supplement after that.

59:42Dr. Mary Claire Haver:You deserve individualized care built on your needs, your goals. Very, very, very personalized for you. If you want a lap panel recommendation that is going to inform you of most of these things, we have our free lap checklist at thepawselife.com, which you can download. We'll email you the PDF that shows all the labs that we recommend to our patients and why we recommend them. We also have scripts on how to talk to your doctor in that. So remember, you're not broken. 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, but suffering is not.

1:00:20Dr. Mary Claire Haver:Thanks for listening today. I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at Dr. Mary Claire and get honest and accurate information on health, fitness, and navigating midlife at thepawselife.com. My new book, The New Perimenopause, is available now everywhere and anywhere you buy books and through our website. If you're loving this podcast, be sure to click follow on your favorite podcast app so you never miss an episode. While you're there, leave us a review and be sure to share the show with the women you love. We would be so grateful.

1:00:59Dr. Mary Claire Haver:You can also find full video episodes on YouTube at Dr. Mary Claire. Unpaused is presented by Odyssey in conjunction with Pod People. I'm your host, Dr. Mary Claire Haver.