Ep #182: Clearing Up Misconceptions Around BHRT

By: Dr. Sherry Price

Health, Habits, and Epic Living with Dr. Sherry Price | Clearing Up Misconceptions Around BHRT

The Women’s Health Initiative has caused a lot of fear amongst the medical community and the public at large.  Sadly, over 20 years later, there are significant misconceptions and misunderstandings around hormone replacement therapy among practitioners, pharmacists, health care practitioners, and patients.

Hormones are not to be lumped into one bucket (but many people view them this way).  There are different types of hormones, categories, and formulations. And it is important to know the differences.  Yet, many people don’t.  Not even some practitioners.

Scary, I know.

I want you to know the truth so you can make the best decision for you.

And hormone replacement therapy is NOT just about hot flashes, night sweats, and vaginal dryness (although these symptoms are important too).  There’s so much more to the story than that.

In this episode, I hope to clear up many misconceptions that we have about bioidentical hormone replacement therapy, particularly during the transition from perimenopause to menopause (which can last 5-15 years).

My goal is to empower you with knowledge and provide you with tools so you can become the best version of yourself. 

Join the Intermittent Fasting (IF:45) For Women program, launching on April 7th, 2024! Secure your spot now by joining the waitlist and learn how to banish belly fat and achieve your health goals!

 

What You’ll Learn in this Episode:

  • Why educating yourself about hormones and hormone replacement therapy is crucial.
  • The benefits of replenishing estrogen in your body.
  • What the Women’s Health Initiative study really showed and the common misconceptions surrounding it.

 

Featured on the Show:

 

 

Welcome to the Health, Habits, and Epic Living podcast. I’m your host, Dr. Sherry Price. The goal of this podcast is to educate and enable empowered women to take the next steps towards achieving their health, wellness, and lifestyle goals. Let’s get started.

Hello, beautiful friend. How are you? Well, we are going to start off today’s podcast with an announcement. I will be opening up the Intermittent Fasting 45 group For Women. Starting April 7th will be the launch of it. And I want to let you know that you can get on the waitlist now. I suspect that this time around the program will fill up. So I wanted to let you know that you could get on the waitlist now. IF:45 stands for intermittent fasting and it goes for 45 days, which is why it’s called IF:45 and it’s for women only.

In this program, you will learn all the healthy eating modalities that you need to know about to banish sugar cravings, to stop emotional eating, to reset your gut microbiome, to balance your hunger hormones so that you have more energy and that you enter a fat burning mode. You’re going to learn all the tools that it takes to be successful, to use intermittent fasting as a lifestyle and health maintenance goal.

And I teach intermittent fasting for women particularly, because there’s a way you should be eating if you are still cycling. There is a way you should be eating if you are intermittent cycling or in that perimenopause, almost into menopause phase. And there’s also a way you should be eating to best support your body and your metabolism in menopause and beyond. And I really think it’s critical for women to know about food, the macronutrients and the micronutrients so that they could get all that food offers to us. And then we can look to supplementation if your body needs it.

So in this program, it’s going to be 45 days’ worth of content. Yes, every single day you will be learning and getting videos and tips and staying accountable in the group so that you can look and feel your best for this summer and beyond. As you know, I’m all about empowering women to really embrace their health and their wellness. So if you are interested in IF:45 for Women, you can join the waitlist now on my website at www.epicyou, that’s E-P-I-C-Y-O-U.com.

And in speaking about empowering women to have health, vitality, longevity now and for years to come, what I want to focus on today is really the misconceptions that many of us have had around hormone replacement therapy, and particularly as you transition from perimenopause into menopause.

I recently went to the A4M meeting, which is a meeting focusing on bioidentical hormones, how they should be used and how they shouldn’t be used in patients. And I found this meeting so enlightening. So I wanted to share a few highlights from the meeting that I attended and look at the misconceptions that many people have, including physicians, including pharmacists, including healthcare practitioners in this space.

Now, to start off, I want to talk about menopause. And menopause is that terminology, definition that was just devised by men, to say it is 12 months without a period now you are christened and now you are in menopause. So that’s just a one-time occurrence. And I’ve had experts on this podcast before to talk about what menopause is. We put so much focus on menopause. However, all the changes leading up to menopause are happening 10 to 15 years prior to that one date where we say menopause has happened.

So 10 to 15 years’ worth of wonky hormones, changes in our body, symptoms happening in our bodies. And as women, I don’t think we are talking enough about this. If you look at the physicians in this space, if you look at the pharmacists in this space, if you look at nurses in this space, they all talk about how they did not get much training at all in their curriculum around menopause. And certainly hardly any training about the 10 to 15 years prior to menopause, which we call perimenopause.

So I don’t want people to think that menopause is just really limited to two symptoms that we hear a lot about, hot flashes and night sweats. That’s what gets the attention. That’s what people think is menopause, but it’s so much more than that. Other symptoms of menopause, do you know what they include? They include, I’m having difficulty sleeping. I used to be able to sleep through the night and now I’m not.

I’m having difficulty concentrating. My focus used to be right on target. I used to be able to get a lot of work done, but I notice my mind wanders. It gets easily distracted. Or I notice I can’t find words, I’m speaking and it’s on the tip of my tongue and I had the word, but it’s just, I can’t remember it. Or I can’t remember the adjective or people’s names. It’s more likely around adjectives and describing something. Perimenopause symptoms can include these wildly fluctuating mood swings.

It can also be, I feel, a little less like myself. I used to know what I liked. I just used to feel right on cue and in touch with myself. And now I’m not feeling really aligned. And I feel like there’s a part of me that’s missing. I could feel depressed. Headaches also can be a part of the perimenopause symptoms as well as a racing heart, vaginal dryness, painful sex, sex that feels like sandpaper or razor blades. I’ve heard that described in some of my clients.

Poor memory, as well as decreased energy, I used to have so much more energy and now I’m not feeling, really, I feel really fatigued or I don’t want to get out of bed. And as I mentioned, it’s not just in menopause that people feel these symptoms. They feel them for years prior to menopause taking place. Now, there’s a whole host of other symptoms that I hear about from my friends transitioning through this, hear about it from my clients transitioning in this phase, different body smells, different body odors that come up.

And so I think having a real discussion around this, so women know what to expect. I mean, if you’re even in your 20s and 30s, it’s good to know what’s in front of me? What should I know about when I get to the next phase of my life? And if you’re in that phase now, you want to know so that you can really make educated decisions regarding your health.

It’s really important to me that I empower you with knowledge and have women be the CEO of their own healthcare and not just outsource it to physicians or whoever’s taking care of them. Yes, they should be an important player in our healthcare and in our wellness, but sometimes they don’t have all the information or they’re not staying up to date. And so I want us to take on that responsibility where we are in charge of our health and our wellness.

And I also want to empower you to seek out practitioners who are really true experts in this space and who want to partner with you and give you tools, the information to make the decision that’s right for you. So to start off, I want to talk about hormone therapy. And I’m going to talk about it as hormone replacement therapy. So hormone replacement therapy, millions of women were taking hormone replacement therapy until about 2002.

Hormone replacement therapy was widely embraced until this one study came out called the Women’s Health Initiative. And it was halted early because of some risks that were found. And this is what changed practitioners’ minds, the public’s mind, and has really been, which I’ll talk about here soon, a great disservice to women and the whole medical community. Because now there is so much fear around hormone replacement therapy because of this study.

So in this study, there were three arms of the study really, but I’m going to talk about two. And the first arm of the study was a combination of estrogen therapy plus progestin therapy and this arm was stopped early. So the trial was stopped early and halted because of the increased risk of breast cancer that was found. And of course, this made headline news and blasted all throughout the country and the use of hormone therapy in the United States because of this one trial plummeted by 80%.

I think I heard the statistic at the meeting that there were 55 million women on hormone replacement therapy. And once this study came out, and talked about the risk of blood clots, strokes, breast cancer that came from this study, that was reported early, by the way. That all these women wanted to come off their hormone therapy and hormone replacement therapy went down to five million women were still taking it from 55 million. A huge decrease.

And so I’ve heard experts talk about this. This was a press release conference. This was before this study was even published in a medical journal that the news media sources got wind of this, heard this. And then all you saw in Time Magazine and all the newspaper reports was that hormone replacement therapy was dangerous.

When in fact, there was another arm of the study, which was just estrogen use, and that showed protective benefit. However, the news had already been out that hormone replacement therapy is dangerous. And we’re going to talk a little bit more about this arm of the study with the estrogen and progestin component.

Since then, I want to let you know that a 18 year follow-up study came out in JAMA, which is a highly regarded medical journal. That showed hormone use therapy, whether it was estrogen alone or estrogen plus progestin, five to seven years was not associated with a risk of all-cause mortality, cardiovascular disease, cancer mortality due to a cumulative follow-up of 18 years.

So this study has come out, basically saying that hormone replacement therapy has not been shown to increase a risk in many of these conditions like all-cause mortality, cardiovascular disease, cancer. However, there’s still great fear amongst practitioners and patients around hormone replacement therapy. And what we now know by looking at that original trial of the Women’s Health Initiative, that it was predominantly thought that the progestin component was thought to be the drug that led to the increased risk of breast cancer.

And what I want you to know is that progestin is a synthetic hormone, and it’s not considered a bioidentical hormone. So this is where it gets confusing because we’re looking at this Women’s Health Initiative trial, and they used an estrogen which was synthetic and not bioidentical, as well as they used a progestin, which is different than progesterone, which is bioidentical.

So they used two synthetic hormones, and they didn’t use bioidentical hormones, which we have a plethora of research already, showing how much benefit they provide women going through the perimenopause to menopause transition. So while the initial data coming out from the Women’s Health Initiative and that press release, which scared everybody and took everybody off hormone replacement therapy, subsequently, we’ll go back and look at that trial.

And even the investigators who originally did that trial did say that we don’t see the risk that we initially thought. And following up these patients for additional 18 years, we don’t see an increased risk. But yet we get fearful of even using bioidentical hormones, which have their own data and show so much reduced risk of many diseases. And that’s where I’m concerned because that’s where I feel people aren’t really comparing apples to apples. They say that all hormones are the same, or they think that all hormones are the same. And that’s not true.

The Women’s Health Initiative study used estrogens that came from horse urine. That is not bioidentical. And I like how Dr. Gersh had said it when I interviewed her on the podcast. She goes, “If the horses don’t want it and they pee it out, why would we want it?” So I want to just point out that bioidentical hormones have been studied. They have a plethora of data and they are not the same hormones that were done and used in the Women’s Health Initiative study.

And yet I find so many people reluctant and resistant and think that all hormones cause cancer, blood clots and strokes, and nothing could be further from the truth. And in fact, there are many studies out there and many authors that say, “When women take estrogen” and we’re talking about bioidentical estrogen, which I’ll talk about here in a moment, “Combined with natural, micronized progesterone”, which is the bioidentical kind of progesterone, “No increased risk of breast cancer has thus far been observed in any study.”

And yet, when you talk in your women’s circles, what’s the common risk everybody talks about when they talk about going on hormone replacement therapy? They’re all worried about breast cancer. And I have to tell you, I believed that story as well, because I was just coming into practice as that Women’s Health Initiative study came out. And I remember everybody talking about, “Whoa, hormone replacement therapy is dangerous.” And not anybody talking about the difference between synthetic and bioidentical hormones.

And I have been studying furiously on this topic to educate myself because I am a woman in perimenopause and I want to know what I should do best for my health. And there are several great books, there are excellent resources on this topic. And there are great review articles, great research that has been done, that’s helped guide me on my decision of starting bioidentical hormone therapy for myself.

So as you can imagine, this big trial was life changing for a lot of women. It changed guidelines. There were organizations that then recommended against using hormone replacement therapy. And then of course, what physician wants to put their license in jeopardy by going on and prescribing hormone therapy when all the associations were saying, no, this is not safe and please don’t prescribe.

And one of those organizations, the North American Menopause Society updated their guidelines back in 2017 to say that they now embrace the use of hormone replacement therapy to take an individualized approach. They no longer recommend the lowest dose for the shortest period of time because they do see that there’s long term data to say that women on these should be on the appropriate dose, the replacement dose.

If you’re going through perimenopause and your estrogen is lowering and as you go into menopause, it’s going to continue to be lower and you’re going to continue to lose estrogen that we should be replacing that. So to use not just the lowest dose, but actually to replace the dose and no longer use it for the shortest period of time. Because there is benefit to the body in multiple facets, we’ll get into, for using hormones. And to use evidence-based information to determine the appropriate use as one should do as a clinician.

So my goal in presenting the rest of the information and this information to you is not to tell you, you should be on hormone replacement therapy or you shouldn’t. It’s just to help educate you about what the current research supports and states and also to highlight and show what hormone replacement therapy does.

So one aspect that I want to get into is when you replenish estrogen, what are the benefits of doing that back to the body? Well, I’ll tell you that estrogen being replaced has been shown to build bones, prevent bone fractures. It’s been vital to your gut lining and healing your gut microbiome, preventing leaky gut and dysbiosis. It has been shown to prevent cardiovascular disease.

And if you want to research, the elite trial was a great trial highlighting this where women who started estradiol within a couple of years following menopause showed a 50% reduction in the rate of progression of atherosclerosis. There have also been other trials that have been done that support there is about a 45 to 50% reduction in cardiovascular disease, not only reduction, but also regression of atherosclerosis.

Proper estrogen replacement therapy has also been shown to be brain protective or neuroprotective. And it’s associated with a lower incidence of Alzheimer’s disease, providing greater focus, memory, and cognition. It’s shown to be protective against strokes. It’s an immunomodulator. And not only that, we know it’s a vital role in reducing hot flashes, night sweats, as well as vaginal dryness and vaginal atrophy.

As I opened up this show, we talked about the common symptoms people talk about with menopause is around hot flashes and vaginal dryness and night sweats. But there is so much more to hormone replacement therapy than just ameliorating those three symptoms. And so when we know a woman is going into perimenopause, we know that her estrogen is going to start being wonky, it’s going to start fluctuating. She may get greater lows, she may get higher peaks. And we know that progesterone decreases over time.

And we also know that testosterone begins to decrease over time starting after the age of 35. And so this is known as endocrine aging. Our endocrines, our hormones are aging. We are getting older and there’s a decline. And so endocrine aging has been found to accelerate chronological aging in the brain of women years before the onset of Alzheimer disease symptoms.

So knowing that, I look at hormone replacement therapy as it’s protecting my brain, it’s protecting my vessels, it’s protecting me from heart disease, it’s protecting me from leaky gut, it’s protecting my bones from becoming frail. And yes, I get side benefits in that I don’t have hot flashes, night sweats and vaginal atrophy and great sex for a longer period of time. So to me, as I’m making this decision, I see a lot of benefits without many risks.

So when I’m educating women on this, or I’m talking with my friends, because a lot of my friends are around the same age, and we’re all transitioning in this. I just want to stand up and start pounding my fists on the table. It’s not just about hot flashes, night sweats and vaginal atrophy. There is so much more benefit that I don’t think we realize until we’re reading the literature and really digging deep into this critical decision in our life.

Now, I want to transition and talk a little bit about estrogen. And so we talk about estrogen as one word thinking it’s one thing. And as Dr. Gersh has mentioned, and other people that I’ve had on the podcast, estrogen is really a broad umbrella term because we have different types of estrogen in the body. The most common ones are E1, E2 and E3. And I’ll go into what all those stand for, but they’re just basically estrogen one, estrogen two, estrogen three.

So estrogen is a family really of three different types of estrogen that we make in our body. And estradiol or E2 is considered to be the most potent estrogen that we make, particularly in our menstrual years. And that’s when it’s in the highest concentration. It’s also considered to be a preventative strategy for the reduction of bone loss, bone fractures, new onset diabetes, cardiovascular disease, and all-cause mortality.

And if we go back to the Women’s Health Initiative study, which got a bad rap, which I talked about with the estrogen plus progestin arm. If you looked at just the estrogen only arm, it was in fact associated with a lower risk of breast cancer, but that’s not what people heard. So be careful when you are educating yourself on this, that you are being educated from people who are educated on this topic and not just hearsay from the press, because this is a very important decision for a woman to make.

So I talked about not all estrogens are the same. We talked about there are synthetic estrogens and a lot of those are found in birth control pills. And so if you are a woman and you’re on a birth control pill and you say, “I’m on a hormone replacement therapy.” That is not hormone replacement therapy. That is prevention of conception. That is birth control. That is not equivalent to hormone replacement therapy for many reasons. And most of those products contain synthetic hormones, not bioidentical hormones.

So you can see this topic gets really confusing because there are layers to this. Now, I talked about estrone, that’s E1. That is the type of estrogen that starts to predominate in the woman’s body as she goes through menopause because we start to lose E2 estradiol, which is the predominant estrogen that we have when we are cycling. And there’s also estriol, which is E3.

Now, estrone or E1 when you go through menopause. That tends to increase. And that is the type of estrogen you have when you also have greater body fat or visceral fat. And that visceral fat will go on to create more estrone or E1 and estrone goes on to create more body fat. So you can see why a lot of women, now, this is not the only reason, but why women do gain weight during that perimenopause to menopause transition. Most women will tell me that they put on about 20 pounds as they go into menopause.

Now, what’s interesting to note is that E2 or estradiol decreases abdominal adiposity, which is basically belly fat, and it’s known to be a body fat shredder. So that might be another reason that’s beneficial to going on proper doses of hormone replacement therapy because we know estradiol or E2 decreases in perimenopause and really decreases and is almost non-existent in menopause.

So I wanted to cover the misconceptions around hormone replacement therapy where everybody just seems to lump all hormones all together in one category. And I really want to delineate for you that there are different types of hormones, different categories of hormones, and different layers to the hormones. And when we’re talking about estrogen, I think a lot of people just think of it as one drug and one compound, when really it’s a family of compounds.

And so when people tell me they’re on hormone replacement therapy, I say, “Well, what form of estrogen? What type of estrogen? Is it E1? Is it E2? Is it E3? Is it synthetic? Is it bioidentical?” And personally, I think that’s really important for you to know for yourself because you want to be on the one that has all the protective effects and all the beneficial effects so you can be the healthiest version of yourself.

And I will tell you that progestins, which are synthetic, and synthetic estrogens have vastly different outcomes when it comes to neuroprotection, inflammation, neuromodulation, than do their bioidentical counterpart hormones. And one thing I really want you to hear me is that this is very confusing. I was confused even as a pharmacist as I was peeling back the layers and had to do more and more research to find the answers.

And at this conference that I attended, I was talking with some physicians, some nurse practitioners that were there, psychiatrists that was there. We were talking about all the ways that we were learning at this conference and misconceptions that we had coming into the conference. And in fact, I was working with a client last week who came to me and says, “My practitioner put me on bioidentical hormones.” And I looked at the prescription that she told me she got and I said, “This is not bioidentical.” And she’s like, “Oh.”

And so she went back to her practitioner. The practitioner says, “Well, I don’t know what bioidentical means.” And so I had helped her educate her physician on knowing the differences between synthetic hormones and bioidentical hormones. And I mean this in all due respect because really we haven’t been educated on menopause and the differences in hormones in many of our traditional programs. If you are educated on this, most likely you learn this on your own.

So I think it’s very important that we get this right. And I really want to be an advocate for women understanding their health and their healthcare needs as well as the medicines that they take. Now, also I want to bring into this conversation progesterone because progesterone should be considered for anyone who is taking estrogen. And of course, I’m talking about bioidentical estrogen in the form of estradiol. We used to say, “Just put women on progesterone if they had a uterus, they didn’t need it if they didn’t have a uterus.” And that is no longer the thought process.

The thought process and the studies show that progesterone should be considered for everyone who is taking estrogen in the form of estradiol. And when you’re talking about progesterone, that is the form you want to be on, not the synthetic version. The synthetic version, the MPA was thought to be the reason there was the increased risk that was seen in the Women’s Health Initiative.

And so synthetic progesterone is found in most of the IUDs out there. In fact, I had one until I met Dr. Gersh and she’s like, “Why are you on a synthetic progestin?” And I said, “My Ob Gyn put me on it.” She’s like, “You need to get that out. We will get you on bioidentical progesterone.” So the synthetic kind can be found in the IUDs, depo shots, many pills, many of the oral contraceptives. And so you want to get on the right formulation that best supports and protects your body and your health.

Alright, my friend, I don’t want to leave any woman confused on this topic. I think it’s essential that you understand it for yourself. I think it’s essential that you understand it for yourself so you can advocate for yourself, educate others so that we are no longer fearful of hormones. Because if you look at the long list of benefits that bioidentical hormones provide for a woman, there are many. And I understand it’s an individual choice with individual risk involved. And so please discuss that with your healthcare practitioner and be willing to have the discussion.

And make sure that you are being taken care of by a practitioner that understands your needs, is knowledgeable in this area of hormone replacement therapy. And not just prescribing or telling you they only do IUDs or only do birth control pills because I think those would be warning signs that they really don’t understand hormone replacement therapy or they are not the right practitioner to have that discussion with.

And a big reason I am so excited about this is because I did not know the plethora of data, study after study after study, I’m talking hundreds of studies out there that show tremendous benefit to being on bioidentical hormones. Where this one study crept in, was misrepresented and created substantial fear here in the United States around the use of hormone replacement therapy.

So my friend, I hope this podcast was informational and educational because remember, this is not medical advice. Please check with your practitioner if you are considering hormone replacement therapy and if it is right for you. Alright, my beautiful friend, I will see you next week.

Thanks for listening to the Health, Habits, and Epic Living podcast. If you are ready to take the next step to improve your health, wellness, and lifestyle goals, head over to www.epicyou.com to check out my programs and to sign up for my free newsletter. Again that’s E-P-I-C-Y-O-U.com.

Please note that the information in this podcast is for educational purposes only and does not constitute medical advice.

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