August 23, 2025 • 25 mins
The recent FDA roundtable on hormone replacement therapy (HRT) marks a pivotal moment in the discourse surrounding women's health, particularly in the context of menopause and perimenopause. This episode delves into the implications of this groundbreaking event, emphasizing that a reevaluation of the historical skepticism surrounding hormone therapy is both necessary and timely. We discuss the detrimental effects stemming from the mass discontinuation of HRT following the 2002 Women’s Health Initiative, which inadvertently led to increased psychological distress and physical health issues among women. Furthermore, we highlight the importance of comprehensive education for healthcare providers, noting that a mere 20% of OB-GYN residencies incorporate menopause training, thereby contributing to widespread misinformation and inadequate care. As we navigate these complexities, we advocate for a holistic and integrative approach to menopause management, underscoring the need for updated clinical guidelines that reflect contemporary research and the diverse needs of women.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:01):
Ever find yourself at 2amlike, what the actual is happening
to me?
Spoiler.
It's not just your hormones.
It's your life cracking wideopen and no one warned you.
I'm Jenna, clinic CEO,menopause whisperer and recovering
people pleaser turned truth slayer.
And I am Dr. Liana, menopauseexpert and medical rebel who's done
(00:21):
playing nice.
Welcome to Smoke, Mirrors and perimenopause.
We're not here to gracefully age.
We're here to blow shit upwith truth, science and zero filter
to follow.
The show and step into your Idon't give a ERA no shame, all flame.
Let's do this.
All right.
And we're back.
Hey.
(00:42):
All right, so this is going to.
Be a more serious episode.
I don't know if we can have areally serious.
I don't really know if that'spossible, but we can try.
So we're going to be talkingabout, we're going to be talking
about the FDA news.
(01:06):
Like it's, you know, there'sbeen a real big turning point in
for women's health and hormone therapy.
There was on July 16th.
So a little over.
Oh my God.
A month ago now.
A month.
Literally.
Yeah.
Okay.
Okay.
My.
Yeah, per.
Menopause is a time warp.
(01:26):
Have entered a vortex.
So July 16th there was agroundbreaking FDA roundtable on
hormone replacement therapy.
And if you are at all targetedby the algorithm about menopause
and perimenopause, you mayhave seen this.
I'm going to, I'm going toventure to say a lot of people have
(01:49):
it made a lot of big newschannels, a lot of syndicated channels
actually.
But it's a really historicand, you know, long overdue shift
in like just the attentionnationally on the needs for supporting
women in menopause and alsofor serving the pro.
(02:10):
Helping the providers thatserve them too.
So, yeah, it's, it was justreally groundbreaking.
And you know, when prescribedappropriately, HRT can really be
life changing.
And like in life saving, I think.
It'S important for people tokind of understand the history of
HRT because it's somethingthat's been around for decades.
(02:32):
Right.
I think like the first HRT wasreleased sometime in like the 1950s.
Yeah.
So for a very long time womenwere on, on estrogen and there was
treatment for menopause andthere wasn't this big need to talk
about it so much like there is now.
I mean, the reason there isnow is because for the last two generations
(02:54):
or the last 20 plus years,we've been taught that it's not safe
to prescribe hormones.
And that was because of the2002 Women's Health Initiative where
that, you know, there wasthis, this, you know, this thought
(03:14):
that estrogen therapy canactually be, you know, detrimental
to women.
And actually.
And they, they thought that it would.
Or what they found, which wenow know was erroneous or like they
were.
Wrong people, wrong place,wrong study, wrong.
Right.
Like everything.
Yeah, right.
The studies were just like, not.
They, they basically debunked.
(03:36):
They debunked these studies,but these studies were saying that
essentially, you know, like,hormones can cause cancer.
And so we have to take allthese women off of hormone therapy
and if you're on any estrogen,stop it.
So there were lots of women atthat time that were abruptly, that
abruptly had their HRT discontinued.
(03:59):
And also women who were goinginto menopause at the time received
no help.
My mom and like 20 years.
Yeah.
My mom being one of them.
And so there's kind of.
And then, you know, if youwere a doctor, a provider, going
through medical school at thattime or residency, then you were
taught that, like, oh God, weall have to stop hrt, you know, like.
(04:21):
And so, so, yeah, so it was,it was like a mass discontinuation
of hormone replacement therapy.
And then there was, because ofthat, there was this surge at that
time of prescribingantidepressants and there was a rise
in osteoporosis and bonefractures and there was a 26% spike
(04:43):
in cardiovascular events and women.
And so that was, and that we,we knew that information actually
10 years ago.
So 10 years ago we knew thatwe knew how detrimental the mass
discontinuation of HRT was.
So women have been sufferingfor the last 20 plus years.
(05:03):
And along with not just thedocs at the time discontinuing women,
there's been now a 20 year gapwhere we just, like docs don't know
what they don't know.
What we know is that only 20%of OB GYN residencies give any level
of menopause education.
So if you translate that, it'sabout 1 in 5 OB GYNs has any understanding
(05:28):
of what's going on for a womanin perimenopause and menopause.
So it's not even theprovider's fault that they haven't
been able because they justdidn't have the knowledge.
There's just unconsciousincompetence around it.
Right?
Yeah.
Yeah.
And so now things are lookinga little bit different.
I think.
Not only are we talking aboutit as this generation who desires
(05:52):
more, who knows that there'smore for us.
But also all of the sciencethat they thought was conclusive
27 years ago is now totallybeing negated and overturned.
It's completely outdated.
Like, it's, it's, it's eithereither suboptimal or outdated because
the, the, the Women's HealthInitiative was testing, or they were
(06:15):
looking at studies that werelooking at people who are on conjugated
equine estrogen, which is not synthetic.
Synthetic hormones.
Yeah.
So that's a synthetic hormone.
That is not a bioidentical hormone.
And a bioidentical hormone iswhen the hormone that you're taking
looks exactly like the onethat your body makes.
Yep.
The.
And in layman's terms,conjugated equine estrogen is horse
(06:39):
urine.
Yeah.
So it's, it's, that's theinitial backbone.
Right.
Of what the manufacturer takesand then get, you know, gets estrogen
from.
Right.
And then they, they made itinto, like, a pill.
So anyway, that's, that's justthe pharmacy of it.
But then also they looked atmedroxyprogesterone acetate.
So that medroxyprogesterone isnot actually, again, bioidentical
(07:02):
progesterone.
That is a fake progesterone.
So I, I, It's a progestin,which is a progesterone, like, substance.
So it's not actually progesterone.
Right.
But it's misleading because ithas the word progesterone in it,
which is really frustrating to me.
So anyway, there's so manydifferent, you know, we like.
(07:25):
And so anyway, in the FDAroundtable, what they talked about
was, you know, they nowemphasized that there's the, the
importance of differentiatingoutcomes of women by their age, because
the average participant of theWomen's Health initiative was about
63 years old.
They also noted the importanceof, like, the route and the formulation
(07:47):
of how you take what you'retaking and how you take it.
So, you know, they weren'treally looking at bioidenticals back
then.
Right.
And so.
Yeah.
And then, you know, I feel like.
There were no other factorstaken into consideration either.
Right.
Like, no one was screeningthese women to understand, like,
what were their healthhistories, what were they potentially,
(08:09):
like, genetically, you know,prone to, how was their lifestyle?
Like, what were those types of things?
Right.
Well, that, those exactdetails I choose to know, but yeah,
I mean.
Yeah, well, anyway, so, soanyway, they, there, there was this
big.
So what's really good aboutthis was that they acknowledged the
(08:29):
lack of education access andthey acknowledged the lack of clear
clinical guidance ondelivering menopause treatment to
providers.
So that's huge because nowthat we have all this menopause education
and people are looking at itand hearing about it on TikTok, on
social media and all the things.
Right.
They are wanting to go totheir provider and ask questions,
(08:51):
but all the providers are,like, not trained.
And so now there's.
We have the supply, we havethe demand, but the supply is low.
Yeah.
Which is why we're starting,obviously, the modern menopause movement.
But, you know, it's a big deal.
Like, you know, a lot of womennow are going to go to their provider
and, like, demand help andcare, and they're going to be providers
(09:12):
who may think they know whatthey're doing or they're going to
do it in a way that is more onthe conventional side and the less
holistic side.
When, you know, in.
In our opinion, right.
In our world, our companyculture and our.
The way that we practicemedicine and deliver care is that
we deliver a holistic,integrative and functional approach
to midlife, to hormones inmidlife, hormone changes and menopause
(09:36):
perimenopause.
So that, to me is concerningthat there's going to be a lot of
people missing the boat on theholistic things to do for menopause
because, you know, it's like,lifestyle's everything, too.
Right.
Like, if you go in, if you gointo perimenopause and menopause
with your adrenals tanked,you're going to have a bad time.
Yeah.
(09:57):
Right.
Because when the ovaries beginto fail, the body then relies on
the adrenals to produce sex hormones.
Right.
So if your adrenals, which areyour major glandulars that produce
stress hormone.
So if you've been running, youknow, if you've been driving your
car with the parking brake on,basically, and those adrenals are
shot, then you have like,there's no gas left.
(10:17):
There's no gas left in thetank of the ovaries.
And then there's.
And then your gas tank in thetrunk is empty as well.
Right, Right.
So, yeah.
And even still, when women arebeing treated with hrt, their adrenals
should be addressed.
Sure.
You know, and that's somethingthat a lot of providers are not trained
in.
You know, there's a lot offamily practice and primary care
(10:39):
providers prescribing andtreating hypothyroidism and thyroid
issues without looking at the Adrenals.
And you can actually make thethyroid problem worse when you're
not addressing hormone signalsignaling upstream from the thyroid.
So if you're not looking atthe hypothalamic pituitary axis and
assuring and addressing thatis imbalance before just blanket
(11:01):
giving Synthroid and thyroidmedication, you're missing the bolt
and you could make someonefeel worse.
Yeah, and we know that that'strue because how many people do you
know, like on Synthroid,Levothyroxine or thyroid replacement
that still don't feel better,even though technically they should?
Yeah.
And then, and then even if youwere to throw hormones on top of
(11:23):
that without looking atthyroid, without looking at adrenals.
Right.
Like, everything's connectedand everything needs to be assessed
in the process.
So there's a, there's amethodology here that needs to be
undertaken.
It's not just prescribing hormones.
Right, Exactly.
So that's my big concern.
So anyway, they also, sohere's what else.
(11:44):
They went over there.
They actually had patientperspectives and there were women
who like, got, it was likeseveral hour thing.
There were women who spokeabout the psychological and the physical
toll of being untreated, theanxiety, the sexual dysfunction,
the osteoporosis, and thenlike the biggest thing, you know,
(12:04):
the sleep disruption, the insomnia.
And there was this consistenttheme too that was across the board
of like, oh, my God, I'm so relief.
I'm so relieved after startinghrt because now, like, there's so
many things that are better.
Right.
It was like I started so many things.
(12:25):
I, I, I even.
They put me on moodstabilizers for anxiety, put me on
antidepressants, and justnothing helped until I started hrt.
So that was really amazing.
Yeah, I was, I was on a callwith a new client this morning who
was saying that she hadlifelong depression and anxiety.
So it wasn't even likesomething that hit her in midlife
(12:47):
necessarily.
It was something she wasstruggling with, which worsened in
midlife, obviously.
What we do know is that out oflike the top 10 symptoms of menopause,
perimenopause, and menopause,of which there are over 100 out of
the top 10, 50 to 90% areactually mental, emotional, and not
even physical physiologic inmany cases.
But this woman was saying thatshe started hormone replacement therapy.
(13:11):
She said she was doing shotsof testosterone, which was way, way,
way too much.
Then she backed back to doingsome compound cream, which was way
too little.
So she ended up findingsomeone who would give Her, a pellet.
But what was happening waswhen she was like early in the pellet
process, she's getting theaccurate dose of the testosterone.
She felt amazing.
She felt on top of the world.
But over time the, you know,the effectiveness and the delivery
(13:34):
mechanism, it kind ofdownregulates, so you're not getting
as much.
So she would actually slipback into that super like anxious
and depressive state based onthat, like whatever two month or
three month time frame ofpellet lifespan.
So I just found that superinteresting just how impactful the,
the testosterone specificallyfor this woman was.
(13:56):
But yeah, women feel like theyget their life back.
So they've been medicatinganxiety, depression with antidepressants
and other types and sleep aidsand those types of medications when
really they were just hormone deficient.
Wow, that's wild.
Yeah.
Another thing that theybrought up was the regulatory challenges
(14:17):
like the, the regulation andthe black box warnings for certain
medications.
So there were some doctors whospoke to like how overly broad, outdated
and fear inducing.
The, the black box warningswere on Medicare, on estrogen products.
(14:37):
And they also, you know, toldpeople that there were warnings,
you know, weren't the warnings.
Those black box warningsreally are reflective of the Women's
Health Initiative drugs ratherthan like the modern formulations
that we all have, which is sovery different because now we have
transdermal, we, we do havesome things that are oral, we have
(14:57):
some medications that are, youknow, systemic or local.
Right.
There's injectables, there'sthe pellets, the trochees, there's
all these things.
Right.
There's so many different routes.
And so the clinicians werelike urging the FDA to create different
warnings that were more agespecific and route specific, like
depending on how you took it,which I think is appropriate.
(15:21):
And also they requested thatsome of these newer trials and newer
studies be incorporatedinstead of relying on like these
studies from over 25 years ago.
Yeah, I don't even need.
Yeah, so anyway, that wouldrequire funding.
Well, there's studies already out.
(15:41):
There's like, like the Danishosteoporosis prevention study.
There are, there are studiesthat we already have that we can
use that are just there thatare helpful, but they're not like,
you know, these, the, theblack box warnings, the regulations,
all these things are just, arebased, are not based on these newer
(16:02):
studies that have already come out.
They're just still using outdated.
So it's like, hello, we'resitting on a lot, actually we're
sitting on a lot that we cancurrently use to update things.
And we need new fun and weneed funding for new research too.
Because now, like, you know,we've been going through comp.
We've been learning aboutcompounding pharmacies and all that.
(16:22):
Right.
And so I just sent you theformulary for one, and the list is
wild.
There's so many differentthings now.
Like.
Yeah.
You know, sublingualdissolvables, like suppositories,
vaginal rectal.
I mean, it's just, you nasal.
I just.
I just saw a testosteronenasal gel that this one pharmacy
(16:43):
makes, and I was like, wow.
Like, we've come so, so farand people are still struggling.
So it's crazy to me now.
I just listened to bits andpieces of the FDA panel, but did
they talk about the fact thattestosterone is not approved for
women?
Not FDA approved for use inwomen in the United States?
(17:03):
So they talked about it.
They did.
And they talked about how, youknow, there's like these forms that
are.
It's approved for men, but notapproved for women.
And women also actually havephysiologic testosterone in their
body.
It's the most abundant, isn't it?
The most abundant hormone inour body.
(17:24):
And they need.
Yeah, yeah.
And they need it.
So that was really huge.
That was really huge to talkabout that.
And I think.
Yeah.
And beside.
And, and when they brought uptestosterone, they also.
They also did bring up thefact that, like, there's all these
(17:48):
drugs approved for men andsexual dysfunction, but for women
there's like two or somethinglike that.
And.
Yeah, so that's really.
That's really shitty.
Yeah.
Really shitty city for boththe women and the men.
Right.
But what.
That's interesting.
Like, don't you think the menwould be lobbying for that?
(18:11):
Like.
Right.
Please make our women give hera libido back.
Give her something like.
Don't you think men would becomplaining about that?
Yeah, they don't need the helpif they don't have a part, like somebody
to receive that.
Right.
Oh, my God, I don't know.
And that.
And you would think, like, thedrug manufacturers would realize
that too.
Right, right, right.
(18:32):
Oh, my God, that's wild.
So, yeah, a few different.
A couple different points andthen we'll close out.
But, you know.
Yeah.
So there were.
They did talk about breastcancer and risk perception.
(18:52):
So they did.
And this.
I was, I wanted to say this,but the, the experts on the panel
did talk aboutcontextualizing, putting context
around the breast cancer risks relative.
More so to lifestyle than justhormone therapy alone.
So, like, that's A huge win,right, that they.
They urged.
They.
They urged the need to talkabout alcohol, obesity, like all
(19:15):
the lifestyle factors when.
When giving the.
The.
The.
The whole risk of breast cancer.
And also too.
The.
Actually in.
In relooking.
Re.
Revisiting the whi.
The Women's Health Initiativeactually showed that it reduced breast
cancer risk with estrogenalone therapy in.
In that the con.
The conjugated equineestrogen, which is.
(19:36):
Which is crazy.
Which is kind of crazy, right?
Which goes against the whole.
What people took away from it.
And then it also.
They also clarified thatprogestin, which is the fake progesterone,
was also associated with ahigher risk of.
Of cancers.
So that's really interestingbecause I know when the first thing
(19:58):
I tell.
The first thing people ask meis like, oh, is it safe?
Like, so my.
My sister or my aunt orsomebody has breast cancer, so is
it safe for me to take hormonereplacement therapy?
And I have to have a wholeconversation to educate them about
the.
The studies and the risks and.
And also let them know, like,it's okay.
It's not only about what you take.
You know, there's all theseother factors.
(20:20):
Right?
Yeah.
Right.
And also just talk brieflyabout the source of what you're lever.
Because you're not using horseurine like extracts.
Right?
Right, right.
What are you using?
Right, right, right.
So it's bioidentical estrogen,which comes from where it comes from.
(20:41):
So the majority of where I getit, the compounding pharmacies that
are making it.
That I. I'm pulling it into,are making it from wild yam.
Right?
So it's a wild yam.
And then what they do is.
Okay, so.
So that's technically.
Oh, my God.
I had this conversation with aresearcher one time who was like,
no, like, BHRT is.
(21:02):
Is.
Is like totally synthetic.
And I'm like, okay, no, it's natural.
I. I'm not even.
I.
Did I tell you the story?
Uhhuh.
You.
Oh, so you know the backstory.
Yes.
Okay.
I'm gonna save the messy dramafor another show.
Yeah.
So this.
This story was just like.
(21:24):
It was like.
Wait, no, it's so it.
It is natural.
Wild yam.
But yes, the process toextract din, which is the.
The backbone for where theymake the hormones from, is extracted.
It has to be done in a.
In a lab, right?
Like, cleanly.
It's like an organic chemistry process.
Like, yes, it is done in alab, but where it's coming from originally
(21:46):
is.
Is.
Is a biological.
It's Yams, essentially.
Yam.
So anyway, but it looks the,the whole, the whole point is that
it looks exactly like thehormone that your body creates.
So when you take it, your bodyknows exactly what to do with it.
Whereas if you take asynthetic hormone that does that
was not made from wild yam,that is, you know, like the fake
(22:11):
progesterone, then your bodywill semi process it the same way
right there.
Like the same effects don'texactly happen.
There's some other side effects.
Like it's almost like you're,it'll bind to your cell receptor
but then what happens afterthat is, is kind of different.
So that's the problem.
That's a big problem.
(22:32):
And that can change the wayyour whole system works.
Without giving everyone like abiochemistry lecture and molecular
biology lecture.
That's the best way that I candescribe it.
And maybe we'll get into that.
I think people maybe need toknow that the difference between,
you know, and I'll break itdown one day, but it is kind of a
molecular biology lecture.
But anyway, that, that.
(22:53):
Yeah.
So anyway, that's reallyimportant for people to understand
the difference.
And they also did, I'll endwith this.
They did also note thatbecause you know, a lot of BHRT is
cash pay and not covered rightnow by insurance companies.
They did mention health equityand access.
So they talked about thesocioeconomic status of certain,
(23:17):
you know, of certain, like, ofcertain people, Hispanic and black
women.
They talked about, they talkedabout the need for having like mobile
clinics and having Medicaidkind of COVID certain hrt.
So yeah, so it was really good.
It was really eye opening.
And this is a new era.
Really glad and happy to be onthe brink of it.
(23:39):
Yeah, it's awesome.
And you know, it's not even about.
It's really important forpeople to know this is not like about
anti aging and cosmeticsbecause that's really booming right
now.
Like aesthetics and all that,which I'm here for it, I love it,
it's great.
But that's not what this is about.
Like, I think a lot of peopleare lumping this into like, oh, you
(24:01):
go get bhrt, you know, andit's like just to look and stay younger.
But they're not telling menthat when men get testosterone replacement,
right.
They're, they're like, oh, wegotta save, we gotta save his life
and give him testosterone.
Well, same thing for a woman.
Yeah.
And you know, we probablyshould talk about at some point,
obviously not now, but at somepoint about what are the implications
(24:25):
of perimenopause and menopauseon women.
Because I think there's a lotof women who just don't realize that
as we go through thistransition and we find ourselves
in a hormone deficit, whatactually happens cardiovascularly,
cognitively?
Like, yes, we know thesymptoms, we talk about the symptoms,
but what about the risk?
Right?
Yeah, let's talk about that next.
(24:46):
Okay.
All right, cool.
All right, till next time.
All flame, no shame.
See you soon.
Bye.
We hope you love the show asmuch as we love doing it.
To learn more and join jointhe modern menopause movement, visit
modern menno.com that's.
Modern menno.com because thisconversation doesn't end here.
(25:10):
And until next time, keepquestioning the smoke and mirrors.
And remember, you're notlosing your mind, you're finding
your truth.
And a quick but boringdisclaimer just necessary to say
anything discussed in thispodcast is for educational and informational
purposes only and solely as aself help tool for your own use.
We are not providing medical,psychological or nutrition therapy
advice.
(25:30):
You should not use thisinformation to diagnose or treat
any health problems orillnesses without consulting your
own medical practitioner.
Always seek the advice of yourown medical practitioner and or mental
health provider about yourspecific health situation.
Even though I am a doctor andphysician, I am not your physician
and this podcast does notcreate a doctor patient relationship.
Ever find yourself at 2amlike, what the actual is happening
to me?
Spoiler.
It's not just your hormones.
It's your life cracking wideopen and no one warned you.
I'm Jenna, clinic CEO,menopause whisperer and recovering
people pleaser turned truth slayer.
And I am Dr. Liana, menopauseexpert and medical rebel who's done
(00:21):
playing nice.
Welcome to Smoke, Mirrors and perimenopause.
We're not here to gracefully age.
We're here to blow shit upwith truth, science and zero filter
to follow.
The show and step into your Idon't give a ERA no shame, all flame.
Let's do this.
All right.
And we're back.
Hey.
(00:42):
All right, so this is going to.
Be a more serious episode.
I don't know if we can have areally serious.
I don't really know if that'spossible, but we can try.
So we're going to be talkingabout, we're going to be talking
about the FDA news.
(01:06):
Like it's, you know, there'sbeen a real big turning point in
for women's health and hormone therapy.
There was on July 16th.
So a little over.
Oh my God.
A month ago now.
A month.
Literally.
Yeah.
Okay.
Okay.
My.
Yeah, per.
Menopause is a time warp.
(01:26):
Have entered a vortex.
So July 16th there was agroundbreaking FDA roundtable on
hormone replacement therapy.
And if you are at all targetedby the algorithm about menopause
and perimenopause, you mayhave seen this.
I'm going to, I'm going toventure to say a lot of people have
(01:49):
it made a lot of big newschannels, a lot of syndicated channels
actually.
But it's a really historicand, you know, long overdue shift
in like just the attentionnationally on the needs for supporting
women in menopause and alsofor serving the pro.
(02:10):
Helping the providers thatserve them too.
So, yeah, it's, it was justreally groundbreaking.
And you know, when prescribedappropriately, HRT can really be
life changing.
And like in life saving, I think.
It'S important for people tokind of understand the history of
HRT because it's somethingthat's been around for decades.
(02:32):
Right.
I think like the first HRT wasreleased sometime in like the 1950s.
Yeah.
So for a very long time womenwere on, on estrogen and there was
treatment for menopause andthere wasn't this big need to talk
about it so much like there is now.
I mean, the reason there isnow is because for the last two generations
(02:54):
or the last 20 plus years,we've been taught that it's not safe
to prescribe hormones.
And that was because of the2002 Women's Health Initiative where
that, you know, there wasthis, this, you know, this thought
(03:14):
that estrogen therapy canactually be, you know, detrimental
to women.
And actually.
And they, they thought that it would.
Or what they found, which wenow know was erroneous or like they
were.
Wrong people, wrong place,wrong study, wrong.
Right.
Like everything.
Yeah, right.
The studies were just like, not.
They, they basically debunked.
(03:36):
They debunked these studies,but these studies were saying that
essentially, you know, like,hormones can cause cancer.
And so we have to take allthese women off of hormone therapy
and if you're on any estrogen,stop it.
So there were lots of women atthat time that were abruptly, that
abruptly had their HRT discontinued.
(03:59):
And also women who were goinginto menopause at the time received
no help.
My mom and like 20 years.
Yeah.
My mom being one of them.
And so there's kind of.
And then, you know, if youwere a doctor, a provider, going
through medical school at thattime or residency, then you were
taught that, like, oh God, weall have to stop hrt, you know, like.
(04:21):
And so, so, yeah, so it was,it was like a mass discontinuation
of hormone replacement therapy.
And then there was, because ofthat, there was this surge at that
time of prescribingantidepressants and there was a rise
in osteoporosis and bonefractures and there was a 26% spike
(04:43):
in cardiovascular events and women.
And so that was, and that we,we knew that information actually
10 years ago.
So 10 years ago we knew thatwe knew how detrimental the mass
discontinuation of HRT was.
So women have been sufferingfor the last 20 plus years.
(05:03):
And along with not just thedocs at the time discontinuing women,
there's been now a 20 year gapwhere we just, like docs don't know
what they don't know.
What we know is that only 20%of OB GYN residencies give any level
of menopause education.
So if you translate that, it'sabout 1 in 5 OB GYNs has any understanding
(05:28):
of what's going on for a womanin perimenopause and menopause.
So it's not even theprovider's fault that they haven't
been able because they justdidn't have the knowledge.
There's just unconsciousincompetence around it.
Right?
Yeah.
Yeah.
And so now things are lookinga little bit different.
I think.
Not only are we talking aboutit as this generation who desires
(05:52):
more, who knows that there'smore for us.
But also all of the sciencethat they thought was conclusive
27 years ago is now totallybeing negated and overturned.
It's completely outdated.
Like, it's, it's, it's eithereither suboptimal or outdated because
the, the, the Women's HealthInitiative was testing, or they were
(06:15):
looking at studies that werelooking at people who are on conjugated
equine estrogen, which is not synthetic.
Synthetic hormones.
Yeah.
So that's a synthetic hormone.
That is not a bioidentical hormone.
And a bioidentical hormone iswhen the hormone that you're taking
looks exactly like the onethat your body makes.
Yep.
The.
And in layman's terms,conjugated equine estrogen is horse
(06:39):
urine.
Yeah.
So it's, it's, that's theinitial backbone.
Right.
Of what the manufacturer takesand then get, you know, gets estrogen
from.
Right.
And then they, they made itinto, like, a pill.
So anyway, that's, that's justthe pharmacy of it.
But then also they looked atmedroxyprogesterone acetate.
So that medroxyprogesterone isnot actually, again, bioidentical
(07:02):
progesterone.
That is a fake progesterone.
So I, I, It's a progestin,which is a progesterone, like, substance.
So it's not actually progesterone.
Right.
But it's misleading because ithas the word progesterone in it,
which is really frustrating to me.
So anyway, there's so manydifferent, you know, we like.
(07:25):
And so anyway, in the FDAroundtable, what they talked about
was, you know, they nowemphasized that there's the, the
importance of differentiatingoutcomes of women by their age, because
the average participant of theWomen's Health initiative was about
63 years old.
They also noted the importanceof, like, the route and the formulation
(07:47):
of how you take what you'retaking and how you take it.
So, you know, they weren'treally looking at bioidenticals back
then.
Right.
And so.
Yeah.
And then, you know, I feel like.
There were no other factorstaken into consideration either.
Right.
Like, no one was screeningthese women to understand, like,
what were their healthhistories, what were they potentially,
(08:09):
like, genetically, you know,prone to, how was their lifestyle?
Like, what were those types of things?
Right.
Well, that, those exactdetails I choose to know, but yeah,
I mean.
Yeah, well, anyway, so, soanyway, they, there, there was this
big.
So what's really good aboutthis was that they acknowledged the
(08:29):
lack of education access andthey acknowledged the lack of clear
clinical guidance ondelivering menopause treatment to
providers.
So that's huge because nowthat we have all this menopause education
and people are looking at itand hearing about it on TikTok, on
social media and all the things.
Right.
They are wanting to go totheir provider and ask questions,
(08:51):
but all the providers are,like, not trained.
And so now there's.
We have the supply, we havethe demand, but the supply is low.
Yeah.
Which is why we're starting,obviously, the modern menopause movement.
But, you know, it's a big deal.
Like, you know, a lot of womennow are going to go to their provider
and, like, demand help andcare, and they're going to be providers
(09:12):
who may think they know whatthey're doing or they're going to
do it in a way that is more onthe conventional side and the less
holistic side.
When, you know, in.
In our opinion, right.
In our world, our companyculture and our.
The way that we practicemedicine and deliver care is that
we deliver a holistic,integrative and functional approach
to midlife, to hormones inmidlife, hormone changes and menopause
(09:36):
perimenopause.
So that, to me is concerningthat there's going to be a lot of
people missing the boat on theholistic things to do for menopause
because, you know, it's like,lifestyle's everything, too.
Right.
Like, if you go in, if you gointo perimenopause and menopause
with your adrenals tanked,you're going to have a bad time.
Yeah.
(09:57):
Right.
Because when the ovaries beginto fail, the body then relies on
the adrenals to produce sex hormones.
Right.
So if your adrenals, which areyour major glandulars that produce
stress hormone.
So if you've been running, youknow, if you've been driving your
car with the parking brake on,basically, and those adrenals are
shot, then you have like,there's no gas left.
(10:17):
There's no gas left in thetank of the ovaries.
And then there's.
And then your gas tank in thetrunk is empty as well.
Right, Right.
So, yeah.
And even still, when women arebeing treated with hrt, their adrenals
should be addressed.
Sure.
You know, and that's somethingthat a lot of providers are not trained
in.
You know, there's a lot offamily practice and primary care
(10:39):
providers prescribing andtreating hypothyroidism and thyroid
issues without looking at the Adrenals.
And you can actually make thethyroid problem worse when you're
not addressing hormone signalsignaling upstream from the thyroid.
So if you're not looking atthe hypothalamic pituitary axis and
assuring and addressing thatis imbalance before just blanket
(11:01):
giving Synthroid and thyroidmedication, you're missing the bolt
and you could make someonefeel worse.
Yeah, and we know that that'strue because how many people do you
know, like on Synthroid,Levothyroxine or thyroid replacement
that still don't feel better,even though technically they should?
Yeah.
And then, and then even if youwere to throw hormones on top of
(11:23):
that without looking atthyroid, without looking at adrenals.
Right.
Like, everything's connectedand everything needs to be assessed
in the process.
So there's a, there's amethodology here that needs to be
undertaken.
It's not just prescribing hormones.
Right, Exactly.
So that's my big concern.
So anyway, they also, sohere's what else.
(11:44):
They went over there.
They actually had patientperspectives and there were women
who like, got, it was likeseveral hour thing.
There were women who spokeabout the psychological and the physical
toll of being untreated, theanxiety, the sexual dysfunction,
the osteoporosis, and thenlike the biggest thing, you know,
(12:04):
the sleep disruption, the insomnia.
And there was this consistenttheme too that was across the board
of like, oh, my God, I'm so relief.
I'm so relieved after startinghrt because now, like, there's so
many things that are better.
Right.
It was like I started so many things.
(12:25):
I, I, I even.
They put me on moodstabilizers for anxiety, put me on
antidepressants, and justnothing helped until I started hrt.
So that was really amazing.
Yeah, I was, I was on a callwith a new client this morning who
was saying that she hadlifelong depression and anxiety.
So it wasn't even likesomething that hit her in midlife
(12:47):
necessarily.
It was something she wasstruggling with, which worsened in
midlife, obviously.
What we do know is that out oflike the top 10 symptoms of menopause,
perimenopause, and menopause,of which there are over 100 out of
the top 10, 50 to 90% areactually mental, emotional, and not
even physical physiologic inmany cases.
But this woman was saying thatshe started hormone replacement therapy.
(13:11):
She said she was doing shotsof testosterone, which was way, way,
way too much.
Then she backed back to doingsome compound cream, which was way
too little.
So she ended up findingsomeone who would give Her, a pellet.
But what was happening waswhen she was like early in the pellet
process, she's getting theaccurate dose of the testosterone.
She felt amazing.
She felt on top of the world.
But over time the, you know,the effectiveness and the delivery
(13:34):
mechanism, it kind ofdownregulates, so you're not getting
as much.
So she would actually slipback into that super like anxious
and depressive state based onthat, like whatever two month or
three month time frame ofpellet lifespan.
So I just found that superinteresting just how impactful the,
the testosterone specificallyfor this woman was.
(13:56):
But yeah, women feel like theyget their life back.
So they've been medicatinganxiety, depression with antidepressants
and other types and sleep aidsand those types of medications when
really they were just hormone deficient.
Wow, that's wild.
Yeah.
Another thing that theybrought up was the regulatory challenges
(14:17):
like the, the regulation andthe black box warnings for certain
medications.
So there were some doctors whospoke to like how overly broad, outdated
and fear inducing.
The, the black box warningswere on Medicare, on estrogen products.
(14:37):
And they also, you know, toldpeople that there were warnings,
you know, weren't the warnings.
Those black box warningsreally are reflective of the Women's
Health Initiative drugs ratherthan like the modern formulations
that we all have, which is sovery different because now we have
transdermal, we, we do havesome things that are oral, we have
(14:57):
some medications that are, youknow, systemic or local.
Right.
There's injectables, there'sthe pellets, the trochees, there's
all these things.
Right.
There's so many different routes.
And so the clinicians werelike urging the FDA to create different
warnings that were more agespecific and route specific, like
depending on how you took it,which I think is appropriate.
(15:21):
And also they requested thatsome of these newer trials and newer
studies be incorporatedinstead of relying on like these
studies from over 25 years ago.
Yeah, I don't even need.
Yeah, so anyway, that wouldrequire funding.
Well, there's studies already out.
(15:41):
There's like, like the Danishosteoporosis prevention study.
There are, there are studiesthat we already have that we can
use that are just there thatare helpful, but they're not like,
you know, these, the, theblack box warnings, the regulations,
all these things are just, arebased, are not based on these newer
(16:02):
studies that have already come out.
They're just still using outdated.
So it's like, hello, we'resitting on a lot, actually we're
sitting on a lot that we cancurrently use to update things.
And we need new fun and weneed funding for new research too.
Because now, like, you know,we've been going through comp.
We've been learning aboutcompounding pharmacies and all that.
(16:22):
Right.
And so I just sent you theformulary for one, and the list is
wild.
There's so many differentthings now.
Like.
Yeah.
You know, sublingualdissolvables, like suppositories,
vaginal rectal.
I mean, it's just, you nasal.
I just.
I just saw a testosteronenasal gel that this one pharmacy
(16:43):
makes, and I was like, wow.
Like, we've come so, so farand people are still struggling.
So it's crazy to me now.
I just listened to bits andpieces of the FDA panel, but did
they talk about the fact thattestosterone is not approved for
women?
Not FDA approved for use inwomen in the United States?
(17:03):
So they talked about it.
They did.
And they talked about how, youknow, there's like these forms that
are.
It's approved for men, but notapproved for women.
And women also actually havephysiologic testosterone in their
body.
It's the most abundant, isn't it?
The most abundant hormone inour body.
(17:24):
And they need.
Yeah, yeah.
And they need it.
So that was really huge.
That was really huge to talkabout that.
And I think.
Yeah.
And beside.
And, and when they brought uptestosterone, they also.
They also did bring up thefact that, like, there's all these
(17:48):
drugs approved for men andsexual dysfunction, but for women
there's like two or somethinglike that.
And.
Yeah, so that's really.
That's really shitty.
Yeah.
Really shitty city for boththe women and the men.
Right.
But what.
That's interesting.
Like, don't you think the menwould be lobbying for that?
(18:11):
Like.
Right.
Please make our women give hera libido back.
Give her something like.
Don't you think men would becomplaining about that?
Yeah, they don't need the helpif they don't have a part, like somebody
to receive that.
Right.
Oh, my God, I don't know.
And that.
And you would think, like, thedrug manufacturers would realize
that too.
Right, right, right.
(18:32):
Oh, my God, that's wild.
So, yeah, a few different.
A couple different points andthen we'll close out.
But, you know.
Yeah.
So there were.
They did talk about breastcancer and risk perception.
(18:52):
So they did.
And this.
I was, I wanted to say this,but the, the experts on the panel
did talk aboutcontextualizing, putting context
around the breast cancer risks relative.
More so to lifestyle than justhormone therapy alone.
So, like, that's A huge win,right, that they.
They urged.
They.
They urged the need to talkabout alcohol, obesity, like all
(19:15):
the lifestyle factors when.
When giving the.
The.
The.
The whole risk of breast cancer.
And also too.
The.
Actually in.
In relooking.
Re.
Revisiting the whi.
The Women's Health Initiativeactually showed that it reduced breast
cancer risk with estrogenalone therapy in.
In that the con.
The conjugated equineestrogen, which is.
(19:36):
Which is crazy.
Which is kind of crazy, right?
Which goes against the whole.
What people took away from it.
And then it also.
They also clarified thatprogestin, which is the fake progesterone,
was also associated with ahigher risk of.
Of cancers.
So that's really interestingbecause I know when the first thing
(19:58):
I tell.
The first thing people ask meis like, oh, is it safe?
Like, so my.
My sister or my aunt orsomebody has breast cancer, so is
it safe for me to take hormonereplacement therapy?
And I have to have a wholeconversation to educate them about
the.
The studies and the risks and.
And also let them know, like,it's okay.
It's not only about what you take.
You know, there's all theseother factors.
(20:20):
Right?
Yeah.
Right.
And also just talk brieflyabout the source of what you're lever.
Because you're not using horseurine like extracts.
Right?
Right, right.
What are you using?
Right, right, right.
So it's bioidentical estrogen,which comes from where it comes from.
(20:41):
So the majority of where I getit, the compounding pharmacies that
are making it.
That I. I'm pulling it into,are making it from wild yam.
Right?
So it's a wild yam.
And then what they do is.
Okay, so.
So that's technically.
Oh, my God.
I had this conversation with aresearcher one time who was like,
no, like, BHRT is.
(21:02):
Is.
Is like totally synthetic.
And I'm like, okay, no, it's natural.
I. I'm not even.
I.
Did I tell you the story?
Uhhuh.
You.
Oh, so you know the backstory.
Yes.
Okay.
I'm gonna save the messy dramafor another show.
Yeah.
So this.
This story was just like.
(21:24):
It was like.
Wait, no, it's so it.
It is natural.
Wild yam.
But yes, the process toextract din, which is the.
The backbone for where theymake the hormones from, is extracted.
It has to be done in a.
In a lab, right?
Like, cleanly.
It's like an organic chemistry process.
Like, yes, it is done in alab, but where it's coming from originally
(21:46):
is.
Is.
Is a biological.
It's Yams, essentially.
Yam.
So anyway, but it looks the,the whole, the whole point is that
it looks exactly like thehormone that your body creates.
So when you take it, your bodyknows exactly what to do with it.
Whereas if you take asynthetic hormone that does that
was not made from wild yam,that is, you know, like the fake
(22:11):
progesterone, then your bodywill semi process it the same way
right there.
Like the same effects don'texactly happen.
There's some other side effects.
Like it's almost like you're,it'll bind to your cell receptor
but then what happens afterthat is, is kind of different.
So that's the problem.
That's a big problem.
(22:32):
And that can change the wayyour whole system works.
Without giving everyone like abiochemistry lecture and molecular
biology lecture.
That's the best way that I candescribe it.
And maybe we'll get into that.
I think people maybe need toknow that the difference between,
you know, and I'll break itdown one day, but it is kind of a
molecular biology lecture.
But anyway, that, that.
(22:53):
Yeah.
So anyway, that's reallyimportant for people to understand
the difference.
And they also did, I'll endwith this.
They did also note thatbecause you know, a lot of BHRT is
cash pay and not covered rightnow by insurance companies.
They did mention health equityand access.
So they talked about thesocioeconomic status of certain,
(23:17):
you know, of certain, like, ofcertain people, Hispanic and black
women.
They talked about, they talkedabout the need for having like mobile
clinics and having Medicaidkind of COVID certain hrt.
So yeah, so it was really good.
It was really eye opening.
And this is a new era.
Really glad and happy to be onthe brink of it.
(23:39):
Yeah, it's awesome.
And you know, it's not even about.
It's really important forpeople to know this is not like about
anti aging and cosmeticsbecause that's really booming right
now.
Like aesthetics and all that,which I'm here for it, I love it,
it's great.
But that's not what this is about.
Like, I think a lot of peopleare lumping this into like, oh, you
(24:01):
go get bhrt, you know, andit's like just to look and stay younger.
But they're not telling menthat when men get testosterone replacement,
right.
They're, they're like, oh, wegotta save, we gotta save his life
and give him testosterone.
Well, same thing for a woman.
Yeah.
And you know, we probablyshould talk about at some point,
obviously not now, but at somepoint about what are the implications
(24:25):
of perimenopause and menopauseon women.
Because I think there's a lotof women who just don't realize that
as we go through thistransition and we find ourselves
in a hormone deficit, whatactually happens cardiovascularly,
cognitively?
Like, yes, we know thesymptoms, we talk about the symptoms,
but what about the risk?
Right?
Yeah, let's talk about that next.
(24:46):
Okay.
All right, cool.
All right, till next time.
All flame, no shame.
See you soon.
Bye.
We hope you love the show asmuch as we love doing it.
To learn more and join jointhe modern menopause movement, visit
modern menno.com that's.
Modern menno.com because thisconversation doesn't end here.
(25:10):
And until next time, keepquestioning the smoke and mirrors.
And remember, you're notlosing your mind, you're finding
your truth.
And a quick but boringdisclaimer just necessary to say
anything discussed in thispodcast is for educational and informational
purposes only and solely as aself help tool for your own use.
We are not providing medical,psychological or nutrition therapy
advice.
(25:30):
You should not use thisinformation to diagnose or treat
any health problems orillnesses without consulting your
own medical practitioner.
Always seek the advice of yourown medical practitioner and or mental
health provider about yourspecific health situation.
Even though I am a doctor andphysician, I am not your physician
and this podcast does notcreate a doctor patient relationship.
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