July 22, 2025 • 18 mins
In this episode of Wellness Unmasked, Dr. Nicole Saphier discusses the controversial topic of hormone replacement therapy (HRT) for women, particularly during perimenopause and menopause. She emphasizes the importance of understanding the risks and benefits of HRT, the impact of historical studies on current perceptions, and the need for individualized care. Dr. Saphier also highlights the role of lifestyle changes in managing hormonal health and encourages women to make informed decisions based on current scientific evidence rather than outdated fears. Wellness Unmasked is part of the Clay Travis & Buck Sexton Podcast Network - new episodes debut every Tuesday & Friday.
00:00 – Overview of Hormone Replacement Therapy (HRT)
05:09 – Issues with the Women’s Health Initiative Study
10:04 – Current Hormone Treatments and Their Advantages
14:34 – Personalized Health Strategies and Lifestyle Considerations
Follow Clay & Buck on YouTube: https://www.youtube.com/c/clayandbuck
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to Wellness on MASS. I'm doctor Nicole Snaffire and
today's topic, well, it hits close to home. Today we're
going to dive into one of the most controversial and
misunderstood topics in medicine, form one replacement therapy for HRT.
As a woman. If you've been told that it's dangerous
or unnecessary, you're not alone. We all have. But it's
time to set the record straight because the science has
(00:22):
evolved and the stakes for women's health are too high
to ignore. And if you're a man listening to this podcast,
let me tell you, While you are not going to
go through perimenopause or menopause, I guarantee someone in your
orbit is going to because all women do. So you
might learn a thing or two by listening here. So
I would tune in because this will benefit you as well.
The reality is, in medical school, I was actually taught
(00:44):
that it was bad. But I'm going to age myself
just a little bit here. After nearly twenty years since
I have graduated from medical school, I've learned that on
my own, maybe to treat or to not treat peerimenopause
menopausal symptoms, it's not as black and white as maybe
we thought. And one of the most common reasons that
women who are undergoing breast cancer treatment. You know, oftentimes
(01:06):
they have surgery, radiation, sometimes chemotherapy. When that is all
said and done, if they have a hormone sensitive cancer,
oftentimes they will be offered an oral treatment to decrease
their risk of that cancer coming back. Well, that medication
the main side effect it essentially thrusts them into menopause
and women sometimes say the symptoms are far too much,
(01:27):
they can't deal with it, and they're going to stop
taking the medication. Now, as a young doctor, I was
shocked that women would make this choice. They know the
risk of their cancer coming back is slightly increased if
they don't take that medication, But for them, what is
the life worth living if they are unhappy, if they
don't feel well. The older I have gotten, the more
(01:47):
I have begun to understand that it's not really all
about risk reduction when it comes to life, but quality
of life being lived is equally as important. Sometimes physicians
forget this. As patients, you have to be your advocate.
You have to talk to them about your quality of life,
because if you're not enjoying life, we all only get
one opportunity on this earth. You have to make the
(02:07):
best of it. And one of the most frequently asked
questions that I get, whether it's from a patient coming
in from a routine mammogram or I'm giving a speech
and I take questions from the audience, people want to
know what's my personal opinion on hormone replacement therapy for
perimenopausal symptoms. And when I tell them I support it,
most are shocked. But I've gotten confident in my ability
(02:28):
to declare my support for HRT because I refuse to
let twenty year old, flawed data disrupt the lives of
so many women, myself included. And truthfully, it wasn't until
my own personal experience that I decided to do a
deep dive into the data. That is what I'm here
to share with you. So last year I started having
some symptoms of my own. They're very vague, but one
(02:51):
thing was I got a migraine. I've never had migraines.
I'm not a headache person. I had them a little
bit when I was a teenager, but that was it.
As an adult, I don't get headaches, it's not my thing.
But I got a migraine, and then on top of that,
I just wasn't feeling well. I was feeling a little tired,
a little achy. I have a very busy life. It's
kind of attributing it all to that. I also have
(03:13):
an autoimmune disease. So I immediately thought, oh, no, my
autoimmune disease is progressing. Turns out my ovaries are just
taking a break. It may be a permanent break. I
don't know. But I went to my physicians and I
talked to them and I said, something's not going on
with me, or something's not right with me. Thankfully, my
rheumatologist said, we don't think it's the autoimmune disease. I
(03:34):
was also having some other symptoms that I talked to
my gynecologists about, specifically being dysperunia. You can google what
that means, but essentially means discomfort during intercourse. And so
I had the foresight of, you know, the only other
time I have felt this is right after I've had babies.
And what happens right after you have babies, Well, your
hormones drop immediately. So something inside of me was telling
(03:57):
me this could all be related to hormones drop because
I've had free babies. I have felt this way three
times before and it feels kind of similar, and that's
what happened. Yep, my o raees are on a break now.
I'm not going to say I'm in menopause. I'm for
anybody keeping track, I am pretty young to be in menopause.
I am in my early forties, but some people do
go into menopause early menopause, even late thirties, early forties.
(04:19):
But my hormones are down, and so I wanted to
talk about options. My gynecologists actually brought up HRT, and
immediately I got a little bit nervous, and that's when
I said, I need to do my own research to
figure out what's my opinion on HRT. Is it right
for me? What are the risks and benefits for me
as an individual? Because not one person is the same
(04:41):
as the other. We're all different. So we have to
go back in the way back machine to why we
have this group think of HRT being bad actually exists.
In two thousand and two, the largest studies ever done
on postmenopausal women, called the Women's Health Initiative, was terminated early,
and this sent shockwaves all across the medical community. The
(05:02):
study actually linked hormone therapy to breast cancer, stroke, heart disease,
and even blood flots, and the media headlines they were
terrifying and subsequently hormone use by women plummeted. Here's the truth.
The study largely flawed and has nothing to do with
what we are talking about here over twenty years later,
and I'll tell you why these people were more afraid
(05:24):
of the clickbit headlines than to spend time to really
interrogate the whole validity of the study and dive deep
into why it was even stopped early to begin with.
So this large study took groups of women and they
separated them to two main groups. One group of women
had combined estrogen progestrum, the other one had just estrogen. Originally,
the study was supposed to have eight and a half
(05:45):
years of follow up, but after a statistical signal was
seen after a little over five years, they stopped the study.
The decision was based on what's called a statistical threshold
and it was crossed for what they called the global
index risk, which include voted. They saw an increased risk
of breast cancer, stroke, card gacks employed cloths like I
already mentioned, but the absolute risk was very small. For example,
(06:09):
the increased risk of breast cancer was eight additional cases
per ten thousand women per year. Statistically speaking, that is
a very small but for those eight women who got
breast cancer, that's not small at all. Right, here's the issue.
The average age of women in the study was sixty three.
This is long past menopause. The average age for women
to go into menopause is fifty two, meaning from early
(06:32):
forties to early sixties and everywhere in between. That's when
most women go through menopause. If the average age of
the woman in the study was sixty three, that means
they were sampling fifties through their seventies. And this is
not representative of the typical woman starting HRT, who should
be in her forties or fifties. And by the way,
(06:54):
being a woman and getting older are independent risk factors
for breast cancer. So the older they are, they already
have a higher risk of breast cancer just by age alone.
And most participants in the study had underlying risk factors
like obesity and cardiovascular disease. And by the way, obesity
increases your risk of breast cancer, blood clots, strokes, as
(07:16):
cardiovascular disease does, so it wasn't a great sample set,
and it certainly was not representative of the women were
talking about who might benefit from hormone replacement therapy. Again,
younger women, women who are actively trying to keep their
health in check. And the problem wasn't just who they
gave the hormones to, but it was also the hormones
(07:38):
that they gave to these women. So first I want
to talk about the two arms. The one arm with
the estrogen and progesterone because you have to have that
balance there, but the other arm just had estrogen. But
it's a very specific caveat. Only women who have had
a hysterectomy or surgical removal of their uterus can have
estrogen alone. Now why is that, Well, it is an
(08:01):
unequivocal truth that estrogen increases your risk of endometrial cancer.
Endometrial cancer is a cancer that develops in the internal
lining of your uterus. You have to have progesterone to
balance estrogen or else you will have an increased risk
of uterine cancer. So again, the arm could only have
(08:21):
been women who had estrogen if their uters was removed.
But the estrogens that they used in this study is
specifically called conjugated equin estrogen and it's derived from pregnant
horse urine. Yes, you heard me right, Sorry, ladies, science
isn't always sexy. Yeah. Did you know there's a diabetes
medication that's actually derived from the saliva of a HeLa monster,
(08:44):
And there's a common blood thinner that was derived from
rat poison alas this or how medications are. Some of
them are medical marvels and some of them are not
so much more coming up on Wellness Unmasked with doctor
Nicol Sapphire. But the thing with the conjugated equin estrogen
is that it doesn't parallel the estrogen that our body makes,
(09:09):
and it is very different from estrogens that are available today.
These conjugated estrogens, they're a mixture of multiple different estrogens.
Some are human identical and some are not. Metabolism is
very unpredictable. And if the estrogen wasn't bad enough, the
progesterone that they used is a synthetic progesterone that in
subsequent research after that big study, it's been proven to
(09:31):
negatively impact lipid profiles, your mood, rest tissue, and has
also been shown to increase the risk of clotting and inflammation.
So these hormones were not good. And furthermore, they were
taking orally. What's the problem with taking these orally? Well,
it undergoes what's called first pass liver metabolism, and that
(09:51):
means that you consume it and now the liver metabolizes it.
But during that metabolism it increases the blood clotting factors
and what's called a C reactive protein, which creates inflammation.
So these hormones were bad idea in an older, non representative,
higher risk population. This is why I don't like the study. Now,
(10:12):
if we fast forward to what we have available today,
most commonly, you have a seventeen beta estrogyl. This is
a bioidentical estrogen that mirrors the body's natural estigen. On
top of that, you don't take it orally. It's available
in transdermal patches, gels, brays, and this avoids deliver metabolism
and therefore has a lower clouding and inflammation risk. Additionally,
(10:36):
we have what's called micronized progesterone. It's a bioidentical just
like your body makes, and it's safer for the breast
tissue and the cardiovascular profile and has also been associated
with fewer mood side effects and better sleep. And as
someone who diagnoses breast cancer every day, it's really important
for me that this transdermal estragile and the micronized progesterone
(10:57):
combo in a big study did not show increased breast
cancer risk in later observational studies. Great news. So while
all the headlines said perimenopausal menopausal hormones are bad, you
should not consider hormone replacement therapy, it's not that the
hormones are dangerous. Maybe the hormones used in that study,
but it was really just that it's the wrong hormones
(11:19):
were given the wrong way to the wrong people, and
those results were unfairly applied to everyone. Today's hormone options
are safer, smarter, and they're tailored to the unique risk profile.
You can go to your gynecologists or your precision medicine
doctor and they can take a blood test. They can
see exactly where your markers are, what your levels at.
It's not a one size fits all. They can give
(11:40):
you what you need to make you feel better. We
have learned from the past and we cannot let it
paralyze the present. Absolutely not. And if we fast forward
to today, many re analysis and newer studies, they've all
flipped the script. We now know that when started within
ten years of menopause or before the age of sixty,
HRT can actually read use all cause mortality, meaning reduce
(12:03):
everything essentially that can cause death, lowers heart disease risk,
improves bone help, stabilizes mood, improves our sleep, protects our
brain health, our cognitive function, decreases our risk of dementia,
and most importantly, it's making women feel better and is
doing it safely. So, like I said, every woman is
going to face perimenopause and menopause. Some women really struggle
(12:25):
through it, have severe symptoms. Other women have no idea
it's happening, and the only reason they know it's happening
is because they no longer get a period. But here's
the issue. Let's talk about what happens if you don't
treat the natural estrogen loss that happens with age. Estrogen
isn't just about getting your periods, menstrual cycle and getting
pregnant and all that. It also protects our bones, our brains,
(12:47):
our blood vessels, our skin, and our mood. Without it,
women are significantly at higher risk of osteoporosis and bone fractures,
heart disease. Remember that's the number one killer of women,
not cancer, cognitive decline in Alzheimer's disease. Women are more
likely to get Alzheimer's. Why is that because when you
have a decrease in estrogen, we have an increased risk
(13:09):
of Alzheimer's. Anxiety, depression, poor sleep, painful intercourse. All of
this can go along with a decrease in estrogen. It's
important to talk to your doctor about replacing that, not
just because you want to avoid hot flashes. Some people,
some women, actually take it as a medal of honor
or badge of whatever, saying, Oh, it's not that bad,
I can muscle through it. But should we be muscling
(13:30):
through it? It's not weakness going to your doctor and
asking for these hormones. Okay, I understand we all like
to muscle through things. I am guilty of it myself,
But is so much more estrogen is needed for so
many more things. As we get older, our bones just
stop mineralizing. We get weaker. You see those little old
women who are slumped over and their backs are curved,
(13:52):
and they have spinal fractures or broken hip and all
these other things that have a huge risk of mortality
that is because of estrogen loss. Now, of course HRT
it's not for everyone. Not everyone can go out and
just start taking these medications. Women with active breast cancer,
untreated blood clots, liver disease. As I said, women who
(14:12):
have a uterus, you can't just go out and start
taking estrogen. One way to offset that and balance the
estrogen is to have a progesterone ID or take a
balance take that micronized progesterone. You can talk to your
doctor about it. Women with active breast cancer, untreated blood clots,
or liver disease, unfortunately, may need to take a different
approach to manage some of these symptoms and reduce their
(14:34):
risk of illness because taking estrogen can have negative effects
on them. That's why we individualize care. This is not
a one size fits all conversation. And even if you
can take HRT or you can't take HRT, there are
still a lot of other things that you should be
doing in everyday life in addition to HRT to live
your healthiest life. One of the biggest things we are
(14:55):
what we eat. We have to focus on anti inflammatory
and nutrition. I didn't foocus on this in college. In
medical school. The only time that I really started learning
about what I consume and what my family consumes is
after I was diagnosed with an autoimmune disease. So anti
inflammatory nutrition are foods that are high in ovegas threes,
like fish, specifically salmon, big leafy greens, berries. You can
(15:19):
google all the things you want. You can follow me
on Instagram. I like to do a lot of cooking there.
I'm also a big advocate for natural herbs. That's why
I created drop our X, the liquid nutraceutical line, because
I heavily support people taking like Trestrius, tribulus tumoric makaru
oshul ganda. These can help with everything from hot flashes
(15:40):
to sleep, to sexual desire and everything in between, decreasing inflammation,
all of that stuff. It's essential that we take magnesium
and vitamin D to keep our bones strong, and also
it helps with our mood, sleep, hydreene, stress management, all
of those things. I know you're kind of like, yeah, yeah,
we've heard this all before, but the reality is if
you are not geting quality sleep, you are not going
(16:02):
to be fine during the day. It doesn't matter if
you can just power through it. Your body and your
brain need that reset every single night. You should be
prioritizing your sleep just as much as you're prioritizing getting
your maniogram or your colonoscy or anything else, because sleep
is essential and stress management. So many disease, cancer, cardiovash,
goo disease are all linked to stress, the high cortisol levels,
(16:25):
and as we go through menopause and we have all
these hormonal fluctuations, managing our cortisol is a big deal.
One thing you can do, decrease your stress level. Find
things that you enjoy because chronic stress actually accelerates your
estrogen decline. Maybe that's why my estrogen declined so quickly
in my life. I don't know. I'm busy all the time,
but I actually really enjoy my life. That's where I'm
(16:45):
saying that in jest. One big thing for women, and
I'm not going to go deep into this right now
because i think we're going to do a follow up
episode to talk about this, but strength training and resistance
exercise absolutely crucial in perimenopausal and menopose women. You hear
all these stories, see all of these reels online about
women wearing those weighted bests and just walking around. I
(17:08):
mean that itself is a new badge of honor for
women in their perimenopausal age. I admit I do not
have a weighted best, but I may I may be
purchasing this soon because I've been reading a lot about them.
The reality is, building muscle also protects your bones. It
helps regulate your insulin, and it's crucial for your brain
health too. And you wouldn't expect that, but yeah, the
(17:30):
more muscle you have, the more oxygenation you have, the
stronger your bones are. It all comes together. It's like
the circle of life and the lion king it all.
It's not just one thing. You don't just work out
for your muscles. You work out for your brain, for
your heart health, for your family, because you're going to
be around longer for your family. So here's the unmasked truth. HRT,
when used correctly and started at the right time, can
(17:53):
protect women, not necessarily harm them. It can significantly improve
their quality of life and even prolong their life disease free.
It's important though it is started early. If you start
it after you've gone through menopause, the risk benefit may
not be nearly as there the earlier start, probably the
more benefit you will get. So it's time to strip
(18:13):
away that fear, the outdated headlines, and the one size
fits all thinking, because when it comes to hormonal therapy
and women's health, it's time we start making decisions based
on fact and not fear. Thanks for listening to Wellness
on Mass on America's number one podcast network, iHeart. Follow
Wellness on MASS with doctor Nicole Saffire and start listening
on the free iHeartRadio app or wherever you get your podcasts,
(18:35):
and we will catch you next time.
Welcome to Wellness on MASS. I'm doctor Nicole Snaffire and
today's topic, well, it hits close to home. Today we're
going to dive into one of the most controversial and
misunderstood topics in medicine, form one replacement therapy for HRT.
As a woman. If you've been told that it's dangerous
or unnecessary, you're not alone. We all have. But it's
time to set the record straight because the science has
(00:22):
evolved and the stakes for women's health are too high
to ignore. And if you're a man listening to this podcast,
let me tell you, While you are not going to
go through perimenopause or menopause, I guarantee someone in your
orbit is going to because all women do. So you
might learn a thing or two by listening here. So
I would tune in because this will benefit you as well.
The reality is, in medical school, I was actually taught
(00:44):
that it was bad. But I'm going to age myself
just a little bit here. After nearly twenty years since
I have graduated from medical school, I've learned that on
my own, maybe to treat or to not treat peerimenopause
menopausal symptoms, it's not as black and white as maybe
we thought. And one of the most common reasons that
women who are undergoing breast cancer treatment. You know, oftentimes
(01:06):
they have surgery, radiation, sometimes chemotherapy. When that is all
said and done, if they have a hormone sensitive cancer,
oftentimes they will be offered an oral treatment to decrease
their risk of that cancer coming back. Well, that medication
the main side effect it essentially thrusts them into menopause
and women sometimes say the symptoms are far too much,
(01:27):
they can't deal with it, and they're going to stop
taking the medication. Now, as a young doctor, I was
shocked that women would make this choice. They know the
risk of their cancer coming back is slightly increased if
they don't take that medication, But for them, what is
the life worth living if they are unhappy, if they
don't feel well. The older I have gotten, the more
(01:47):
I have begun to understand that it's not really all
about risk reduction when it comes to life, but quality
of life being lived is equally as important. Sometimes physicians
forget this. As patients, you have to be your advocate.
You have to talk to them about your quality of life,
because if you're not enjoying life, we all only get
one opportunity on this earth. You have to make the
(02:07):
best of it. And one of the most frequently asked
questions that I get, whether it's from a patient coming
in from a routine mammogram or I'm giving a speech
and I take questions from the audience, people want to
know what's my personal opinion on hormone replacement therapy for
perimenopausal symptoms. And when I tell them I support it,
most are shocked. But I've gotten confident in my ability
(02:28):
to declare my support for HRT because I refuse to
let twenty year old, flawed data disrupt the lives of
so many women, myself included. And truthfully, it wasn't until
my own personal experience that I decided to do a
deep dive into the data. That is what I'm here
to share with you. So last year I started having
some symptoms of my own. They're very vague, but one
(02:51):
thing was I got a migraine. I've never had migraines.
I'm not a headache person. I had them a little
bit when I was a teenager, but that was it.
As an adult, I don't get headaches, it's not my thing.
But I got a migraine, and then on top of that,
I just wasn't feeling well. I was feeling a little tired,
a little achy. I have a very busy life. It's
kind of attributing it all to that. I also have
(03:13):
an autoimmune disease. So I immediately thought, oh, no, my
autoimmune disease is progressing. Turns out my ovaries are just
taking a break. It may be a permanent break. I
don't know. But I went to my physicians and I
talked to them and I said, something's not going on
with me, or something's not right with me. Thankfully, my
rheumatologist said, we don't think it's the autoimmune disease. I
(03:34):
was also having some other symptoms that I talked to
my gynecologists about, specifically being dysperunia. You can google what
that means, but essentially means discomfort during intercourse. And so
I had the foresight of, you know, the only other
time I have felt this is right after I've had babies.
And what happens right after you have babies, Well, your
hormones drop immediately. So something inside of me was telling
(03:57):
me this could all be related to hormones drop because
I've had free babies. I have felt this way three
times before and it feels kind of similar, and that's
what happened. Yep, my o raees are on a break now.
I'm not going to say I'm in menopause. I'm for
anybody keeping track, I am pretty young to be in menopause.
I am in my early forties, but some people do
go into menopause early menopause, even late thirties, early forties.
(04:19):
But my hormones are down, and so I wanted to
talk about options. My gynecologists actually brought up HRT, and
immediately I got a little bit nervous, and that's when
I said, I need to do my own research to
figure out what's my opinion on HRT. Is it right
for me? What are the risks and benefits for me
as an individual? Because not one person is the same
(04:41):
as the other. We're all different. So we have to
go back in the way back machine to why we
have this group think of HRT being bad actually exists.
In two thousand and two, the largest studies ever done
on postmenopausal women, called the Women's Health Initiative, was terminated early,
and this sent shockwaves all across the medical community. The
(05:02):
study actually linked hormone therapy to breast cancer, stroke, heart disease,
and even blood flots, and the media headlines they were
terrifying and subsequently hormone use by women plummeted. Here's the truth.
The study largely flawed and has nothing to do with
what we are talking about here over twenty years later,
and I'll tell you why these people were more afraid
(05:24):
of the clickbit headlines than to spend time to really
interrogate the whole validity of the study and dive deep
into why it was even stopped early to begin with.
So this large study took groups of women and they
separated them to two main groups. One group of women
had combined estrogen progestrum, the other one had just estrogen. Originally,
the study was supposed to have eight and a half
(05:45):
years of follow up, but after a statistical signal was
seen after a little over five years, they stopped the study.
The decision was based on what's called a statistical threshold
and it was crossed for what they called the global
index risk, which include voted. They saw an increased risk
of breast cancer, stroke, card gacks employed cloths like I
already mentioned, but the absolute risk was very small. For example,
(06:09):
the increased risk of breast cancer was eight additional cases
per ten thousand women per year. Statistically speaking, that is
a very small but for those eight women who got
breast cancer, that's not small at all. Right, here's the issue.
The average age of women in the study was sixty three.
This is long past menopause. The average age for women
to go into menopause is fifty two, meaning from early
(06:32):
forties to early sixties and everywhere in between. That's when
most women go through menopause. If the average age of
the woman in the study was sixty three, that means
they were sampling fifties through their seventies. And this is
not representative of the typical woman starting HRT, who should
be in her forties or fifties. And by the way,
(06:54):
being a woman and getting older are independent risk factors
for breast cancer. So the older they are, they already
have a higher risk of breast cancer just by age alone.
And most participants in the study had underlying risk factors
like obesity and cardiovascular disease. And by the way, obesity
increases your risk of breast cancer, blood clots, strokes, as
(07:16):
cardiovascular disease does, so it wasn't a great sample set,
and it certainly was not representative of the women were
talking about who might benefit from hormone replacement therapy. Again,
younger women, women who are actively trying to keep their
health in check. And the problem wasn't just who they
gave the hormones to, but it was also the hormones
(07:38):
that they gave to these women. So first I want
to talk about the two arms. The one arm with
the estrogen and progesterone because you have to have that
balance there, but the other arm just had estrogen. But
it's a very specific caveat. Only women who have had
a hysterectomy or surgical removal of their uterus can have
estrogen alone. Now why is that, Well, it is an
(08:01):
unequivocal truth that estrogen increases your risk of endometrial cancer.
Endometrial cancer is a cancer that develops in the internal
lining of your uterus. You have to have progesterone to
balance estrogen or else you will have an increased risk
of uterine cancer. So again, the arm could only have
(08:21):
been women who had estrogen if their uters was removed.
But the estrogens that they used in this study is
specifically called conjugated equin estrogen and it's derived from pregnant
horse urine. Yes, you heard me right, Sorry, ladies, science
isn't always sexy. Yeah. Did you know there's a diabetes
medication that's actually derived from the saliva of a HeLa monster,
(08:44):
And there's a common blood thinner that was derived from
rat poison alas this or how medications are. Some of
them are medical marvels and some of them are not
so much more coming up on Wellness Unmasked with doctor
Nicol Sapphire. But the thing with the conjugated equin estrogen
is that it doesn't parallel the estrogen that our body makes,
(09:09):
and it is very different from estrogens that are available today.
These conjugated estrogens, they're a mixture of multiple different estrogens.
Some are human identical and some are not. Metabolism is
very unpredictable. And if the estrogen wasn't bad enough, the
progesterone that they used is a synthetic progesterone that in
subsequent research after that big study, it's been proven to
(09:31):
negatively impact lipid profiles, your mood, rest tissue, and has
also been shown to increase the risk of clotting and inflammation.
So these hormones were not good. And furthermore, they were
taking orally. What's the problem with taking these orally? Well,
it undergoes what's called first pass liver metabolism, and that
(09:51):
means that you consume it and now the liver metabolizes it.
But during that metabolism it increases the blood clotting factors
and what's called a C reactive protein, which creates inflammation.
So these hormones were bad idea in an older, non representative,
higher risk population. This is why I don't like the study. Now,
(10:12):
if we fast forward to what we have available today,
most commonly, you have a seventeen beta estrogyl. This is
a bioidentical estrogen that mirrors the body's natural estigen. On
top of that, you don't take it orally. It's available
in transdermal patches, gels, brays, and this avoids deliver metabolism
and therefore has a lower clouding and inflammation risk. Additionally,
(10:36):
we have what's called micronized progesterone. It's a bioidentical just
like your body makes, and it's safer for the breast
tissue and the cardiovascular profile and has also been associated
with fewer mood side effects and better sleep. And as
someone who diagnoses breast cancer every day, it's really important
for me that this transdermal estragile and the micronized progesterone
(10:57):
combo in a big study did not show increased breast
cancer risk in later observational studies. Great news. So while
all the headlines said perimenopausal menopausal hormones are bad, you
should not consider hormone replacement therapy, it's not that the
hormones are dangerous. Maybe the hormones used in that study,
but it was really just that it's the wrong hormones
(11:19):
were given the wrong way to the wrong people, and
those results were unfairly applied to everyone. Today's hormone options
are safer, smarter, and they're tailored to the unique risk profile.
You can go to your gynecologists or your precision medicine
doctor and they can take a blood test. They can
see exactly where your markers are, what your levels at.
It's not a one size fits all. They can give
(11:40):
you what you need to make you feel better. We
have learned from the past and we cannot let it
paralyze the present. Absolutely not. And if we fast forward
to today, many re analysis and newer studies, they've all
flipped the script. We now know that when started within
ten years of menopause or before the age of sixty,
HRT can actually read use all cause mortality, meaning reduce
(12:03):
everything essentially that can cause death, lowers heart disease risk,
improves bone help, stabilizes mood, improves our sleep, protects our
brain health, our cognitive function, decreases our risk of dementia,
and most importantly, it's making women feel better and is
doing it safely. So, like I said, every woman is
going to face perimenopause and menopause. Some women really struggle
(12:25):
through it, have severe symptoms. Other women have no idea
it's happening, and the only reason they know it's happening
is because they no longer get a period. But here's
the issue. Let's talk about what happens if you don't
treat the natural estrogen loss that happens with age. Estrogen
isn't just about getting your periods, menstrual cycle and getting
pregnant and all that. It also protects our bones, our brains,
(12:47):
our blood vessels, our skin, and our mood. Without it,
women are significantly at higher risk of osteoporosis and bone fractures,
heart disease. Remember that's the number one killer of women,
not cancer, cognitive decline in Alzheimer's disease. Women are more
likely to get Alzheimer's. Why is that because when you
have a decrease in estrogen, we have an increased risk
(13:09):
of Alzheimer's. Anxiety, depression, poor sleep, painful intercourse. All of
this can go along with a decrease in estrogen. It's
important to talk to your doctor about replacing that, not
just because you want to avoid hot flashes. Some people,
some women, actually take it as a medal of honor
or badge of whatever, saying, Oh, it's not that bad,
I can muscle through it. But should we be muscling
(13:30):
through it? It's not weakness going to your doctor and
asking for these hormones. Okay, I understand we all like
to muscle through things. I am guilty of it myself,
But is so much more estrogen is needed for so
many more things. As we get older, our bones just
stop mineralizing. We get weaker. You see those little old
women who are slumped over and their backs are curved,
(13:52):
and they have spinal fractures or broken hip and all
these other things that have a huge risk of mortality
that is because of estrogen loss. Now, of course HRT
it's not for everyone. Not everyone can go out and
just start taking these medications. Women with active breast cancer,
untreated blood clots, liver disease. As I said, women who
(14:12):
have a uterus, you can't just go out and start
taking estrogen. One way to offset that and balance the
estrogen is to have a progesterone ID or take a
balance take that micronized progesterone. You can talk to your
doctor about it. Women with active breast cancer, untreated blood clots,
or liver disease, unfortunately, may need to take a different
approach to manage some of these symptoms and reduce their
(14:34):
risk of illness because taking estrogen can have negative effects
on them. That's why we individualize care. This is not
a one size fits all conversation. And even if you
can take HRT or you can't take HRT, there are
still a lot of other things that you should be
doing in everyday life in addition to HRT to live
your healthiest life. One of the biggest things we are
(14:55):
what we eat. We have to focus on anti inflammatory
and nutrition. I didn't foocus on this in college. In
medical school. The only time that I really started learning
about what I consume and what my family consumes is
after I was diagnosed with an autoimmune disease. So anti
inflammatory nutrition are foods that are high in ovegas threes,
like fish, specifically salmon, big leafy greens, berries. You can
(15:19):
google all the things you want. You can follow me
on Instagram. I like to do a lot of cooking there.
I'm also a big advocate for natural herbs. That's why
I created drop our X, the liquid nutraceutical line, because
I heavily support people taking like Trestrius, tribulus tumoric makaru
oshul ganda. These can help with everything from hot flashes
(15:40):
to sleep, to sexual desire and everything in between, decreasing inflammation,
all of that stuff. It's essential that we take magnesium
and vitamin D to keep our bones strong, and also
it helps with our mood, sleep, hydreene, stress management, all
of those things. I know you're kind of like, yeah, yeah,
we've heard this all before, but the reality is if
you are not geting quality sleep, you are not going
(16:02):
to be fine during the day. It doesn't matter if
you can just power through it. Your body and your
brain need that reset every single night. You should be
prioritizing your sleep just as much as you're prioritizing getting
your maniogram or your colonoscy or anything else, because sleep
is essential and stress management. So many disease, cancer, cardiovash,
goo disease are all linked to stress, the high cortisol levels,
(16:25):
and as we go through menopause and we have all
these hormonal fluctuations, managing our cortisol is a big deal.
One thing you can do, decrease your stress level. Find
things that you enjoy because chronic stress actually accelerates your
estrogen decline. Maybe that's why my estrogen declined so quickly
in my life. I don't know. I'm busy all the time,
but I actually really enjoy my life. That's where I'm
(16:45):
saying that in jest. One big thing for women, and
I'm not going to go deep into this right now
because i think we're going to do a follow up
episode to talk about this, but strength training and resistance
exercise absolutely crucial in perimenopausal and menopose women. You hear
all these stories, see all of these reels online about
women wearing those weighted bests and just walking around. I
(17:08):
mean that itself is a new badge of honor for
women in their perimenopausal age. I admit I do not
have a weighted best, but I may I may be
purchasing this soon because I've been reading a lot about them.
The reality is, building muscle also protects your bones. It
helps regulate your insulin, and it's crucial for your brain
health too. And you wouldn't expect that, but yeah, the
(17:30):
more muscle you have, the more oxygenation you have, the
stronger your bones are. It all comes together. It's like
the circle of life and the lion king it all.
It's not just one thing. You don't just work out
for your muscles. You work out for your brain, for
your heart health, for your family, because you're going to
be around longer for your family. So here's the unmasked truth. HRT,
when used correctly and started at the right time, can
(17:53):
protect women, not necessarily harm them. It can significantly improve
their quality of life and even prolong their life disease free.
It's important though it is started early. If you start
it after you've gone through menopause, the risk benefit may
not be nearly as there the earlier start, probably the
more benefit you will get. So it's time to strip
(18:13):
away that fear, the outdated headlines, and the one size
fits all thinking, because when it comes to hormonal therapy
and women's health, it's time we start making decisions based
on fact and not fear. Thanks for listening to Wellness
on Mass on America's number one podcast network, iHeart. Follow
Wellness on MASS with doctor Nicole Saffire and start listening
on the free iHeartRadio app or wherever you get your podcasts,
(18:35):
and we will catch you next time.
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