Dr Marie Claire Haver, an OB-GYN, at her home in Galveston, Texas. Photo / Arturo Olmos, The New York Times
Dr Mary Claire Haver has amassed a following in the millions, all on the promise that women can thrive through menopause. Not everyone is celebrating her rise.
It was 10 in the morning, and Dr Mary Claire Haver, an OB-GYN, had already recorded a video on solutions for low sex drive for her combined 4 million followers on Instagram and TikTok. Now Haver, 56, was walking on her treadmill while reading a study on female sexual dysfunction.
It was part of her morning routine, but this day, she was being filmed for a documentary series about thriving through perimenopause.
“I’m not thinking about what I’m going to look like in a bikini,” she said to the filmmakers who had gathered in her garage gym. “I’m thinking about what I’m going to look like at 80.” With her shiny black hair, dark-rimmed glasses and lithe physique, Haver looked like the model of youth compared to the Golden Girls menopause stereotypes of yore.
Over the course of two days, in interviews at her home in Galveston, Texas, she repeated to me something she’d said to her audience that morning: if women are proactive, they aren’t destined to slowly decline after their reproductive years. Or, as she likes to say, “Menopause is inevitable; suffering through it is not”.
Six thousand women reach menopause every day in the United States, but there are only about 2300 providers certified in menopause medicine. Many women struggle to find clinicians who are experienced and informed enough to guide them through the transition. The void has been filled by a thriving crowd of menopause influencers, with Haver at the helm. In the past two years, she has arguably done more to educate women about menopause than any other public figure, through her social media platforms and bestselling book The New Menopause. She has called out sexism in medicine, demanded increased federal funding for women’s health research and called on medical schools to better prepare doctors to care for women beyond their reproductive years. And she has crusaded to dispel deep-seated fears about hormone therapy.
On TikTok and Instagram, Haver comes across as authoritative and empathetic. But in her efforts to help women navigate menopause today, she has also drawn criticism from menopause medicine’s longer-serving guard of doctors for recommending hormones for uses that stray from official medical guidelines and, they say, risk harming women. And she has built a multimillion-dollar wellness business, The ‘Pause Life, selling supplements and diet plans in a way that some of her colleagues find ethically questionable. Several longtime menopause specialists and researchers told The New York Times they believed Haver embodied both the promise and perils of menopause care’s next chapter.
“I think she really is trying to advocate and do the right thing, largely,” said Dr Lisa Larkin, immediate past president of the Menopause Society, the field’s top governing body in the United States, which sets the official medical guidelines for hormone therapy and certifies clinicians to practice menopause medicine. But Larkin and others expressed concern that when health care providers sell anything – including their own expertise – on social media, important subtleties are lost or compromised.
Haver hears the concerns, but says she is more interested in helping women.
“I don’t know why God woke up and said, ‘I’m going to give you a megaphone and people are going to listen to you,’ but here we are,” she said. “I just take it with such a responsibility, right?”
Haver grew up in a large Catholic family in southern Louisiana. Her parents owned a restaurant and were perplexed by her desire to forge a career in science and medicine.
But Haver had been deeply affected by losing an older brother to leukaemia when she was 9 years old, and becoming a doctor felt meaningful. She completed medical school in Louisiana, where, like most physicians today, she received only about an hour of instruction on menopause. During her residency in obstetrics and gynaecology at the University of Texas Medical Branch hospital in Galveston, she got about six. (Today, only about 31% of OB-GYN residencies offer a menopause curriculum.)
As a first-year resident, she was told by a male supervisor to watch out for WWs – “whiny women,” she said – who were often in their late 40s and complained of vague, hard-to-pin-down symptoms like brain fog, poor sleep, weight gain and heart palpitations. The implication, Haver said, was that these women didn’t actually have a serious medical condition; they were merely complainers.
During Haver’s final year as a resident, in 2002, the limited menopause care that existed was diminished even further. That year, researchers overseeing the country’s first wide-scale study of health outcomes in postmenopausal women abruptly ended their trial of oestrogen and progestin therapy, after they saw a very small increase in breast cancer among some participants taking oral oestrogen.
The findings are now considered to have been overblown, but nearly overnight, hormones fell out of fashion among menopausal women. By 2007, the number of eligible menopausal women taking them dropped below 5%. It had previously hovered around 40%.
Not long after, she and her husband decided to make Galveston their home. She joined the hospital staff and built a busy OB-GYN practice. For 10 years, she oversaw the hospital’s OB-GYN residency programme.
It wasn’t until 2015, when Haver went through menopause herself at 48 and experienced crippling hot flushes and insomnia, that she began to question the prevailing belief that, beyond prescribing antidepressants and anti-anxiety drugs, there wasn’t much doctors could do to help women feel like themselves again.
Finally, in early 2016, when she felt she couldn’t live another day with her symptoms, Haver asked for oestrogen. At first, she said, choosing to go on hormones felt like “throwing in the towel”. But as her symptoms vanished, she felt happier and more energetic than she had in years – and outraged that women had been deprived of these benefits for so long.
The decision would mark the beginning of Haver’s more renegade approach to treating menopause.
And in 2023, her approach was bolstered by a larger cultural shift. Health care providers say that hormones re-entered the national conversation as a viable treatment for menopause symptoms after The New York Times Magazine published an article by Susan Dominus, titled “Women Have Been Misled About Menopause,” which explained why the earlier research on hormones and cancer risk had been misinterpreted.
Since then, some menopause experts have embarked on an aggressive public awareness campaign to educate women about the potential benefits of hormones and dispel blanket fears about their risks. Today, less than 4% of eligible menopausal women use hormones approved by the Food and Drug Administration, according to the Menopause Society, suggesting that many millions of women are suffering needlessly.
Earlier this year, Haver rallied a constellation of about three dozen physician influencers into a group that calls itself the “menoposse”. Collectively, they have more than 5 million followers on Instagram alone. The menoposse now converses daily via a WhatsApp group. It’s part support group, part advisory board, part hype machine.
A theme runs through Haver’s posts: that women’s bodies need oestrogen, progesterone and testosterone – all of which plunge during menopause – to function optimally, and that taking them not only can help with symptoms, but also help prevent cardiovascular disease and dementia and contribute to long-term health and happiness.
The problem is that studies haven’t definitively proven these claims – at least, the data isn’t considered strong enough for any medical society to get on board with the kind of messaging the menoposse is putting forth.
Everyone the Times interviewed agreed that many more women could benefit from hormone therapy. But longtime menopause specialists said they feared the cultural messaging about it had gone too far in the past few months, glossing over the health risks and creating a misguided perception that hormones are essential for a woman’s general wellbeing as she ages.
The Menopause Society only recommends oestrogen for women dealing with disruptive menopause symptoms, or those at a high risk for developing osteoporosis. It does not recommend oestrogen as a first-line tool for improving overall wellbeing, or for preventing heart disease or dementia for women who go through menopause at the average age.
“Nobody in the Menopause Society is gatekeeping hormones. They’re saying, ‘This is what the research shows; this is what the good quality research shows,’” said Dr Jennifer Gunter, an OB-GYN and menopause specialist in San Francisco.
For these reasons, in its most recent guidelines, the Menopause Society urged health care providers to drop the term “hormone replacement therapy,” and swap it with “hormone therapy” or “menopausal hormone therapy,” to avoid creating the perception that estrogen, progesterone and testosterone need to be replaced as women age. Unlike people with low levels of thyroid hormones or insulin, postmenopausal women with low levels of reproductive hormones can often live long, healthy lives, said Dr Stephanie Faubion, the society’s medical director and the director of the Mayo Clinic’s Centre for Women’s Health.
Despite this, Haver’s message has landed. “Women with no menopausal symptoms at all are asking for hormone therapy to reduce their lifetime risk of heart disease and dementia,” said Dr Nanette Santoro, a professor of obstetrics and gynaecology at University of Colorado School of Medicine, who has been studying and treating menopausal patients since the early 1990s.
Haver and others in the menoposse argue that, while there aren’t yet large, long-term studies establishing the unarguable benefits of hormones for disease prevention, there eventually will be, and women shouldn’t have to wait decades for better care – which is how long it could take to gather enough evidence to change official guidelines.
“I sit in front of patients every day,” she said, and “they just want their lives back”.
In her clinic, Haver discusses all of the risks and complexities of treatment options, including non-hormonal ones. She also couches her recommendations on Instagram and TikTok with disclaimers, and stresses that hormones aren’t right for everybody.
But critics of Haver and the menoposse’s stridently pro-hormone therapy messaging argue this fine print gets lost. “In medicine, there’s a lot of nuance, and nuance doesn’t play on social media,” Gunter said.
At the Menopause Society’s annual meeting in Chicago last month, Faubion said she heard numerous whispers from members about what they perceived as a social media-driven disinformation crisis that was promoting solutions lacking in evidence.
The society’s leaders also told the Times that the stakes had never been higher, since more clinicians were seeking its certification to practise menopause medicine than ever before, and they wanted to ensure they were practising what they considered evidence-based care.
And so, in recent weeks, the Menopause Society has taken steps to try to discourage physician-influencers and their followers in the medical community from routinely making recommendations that don’t align with its guidelines: On September 30, the group released a statement to its members, which include Haver, urging clinicians to stick to the script.
A few hours later, Haver posted on Instagram about the danger of “weaponising guidelines” against women to deny them essential care. She later deleted the post. “I probably overreacted,” she said.
Haver says she sometimes gets too fired up about what she perceives to be barriers to treatment. She has no plans to scale back her crusade to get menopausal women the care she believes they deserve. “Maybe my messaging isn’t perfect all the time,” she said. “But I take the negative, and I say, ‘How can I do better?’” And then, she added, “I keep going”.
This article originally appeared in The New York Times.
Written by: Danielle Friedman
Photographs by: Arturo Olmos
©2024 THE NEW YORK TIMES
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