WEBVTT - Dr Ceri Cashell // Debunking Women’s Hormonal Health & Why Menopause Still Gets Minimal Medical Training 0:00:00.560 --> 0:00:05.760 This is a guide your light network production creating podcasts. 0:00:05.120 --> 0:00:09.200 With purpose because a lot of this doesn't exist in 0:00:09.680 --> 0:00:12.200 tax books, are in guidelines because as you know, you know, 0:00:12.200 --> 0:00:16.479 we only spend one percent of research funding on female 0:00:16.480 --> 0:00:18.799 conditions that aren't cancer, six percent for cancer. But you 0:00:18.840 --> 0:00:21.079 know ninety three percent of medical funding is not going 0:00:21.120 --> 0:00:25.520 to women. There's still menopause and perimenopause still get minimal 0:00:25.560 --> 0:00:29.280 lip service and medical training art to medical school push 0:00:29.320 --> 0:00:33.760 graduate training still hardly anything. You know, So we're trained 0:00:33.840 --> 0:00:36.159 to treat man and women or an afterthought. 0:00:36.600 --> 0:00:39.960 Welcome to the Things you Can't Unhear podcast. 0:00:40.640 --> 0:00:44.760 I'm your host, Maritza Barone. Get ready to hear moments 0:00:44.800 --> 0:00:46.040 that will help you to. 0:00:46.080 --> 0:00:48.479 See the world differently and. 0:00:48.640 --> 0:00:53.280 Inspire you to become the happiest, healthiest and kindest version 0:00:53.479 --> 0:00:59.760 of you. On this episode of Things You Can and 0:00:59.840 --> 0:01:03.840 here we delve deeply into the topics of verimenopause, menopause 0:01:03.880 --> 0:01:07.360 and hormonal health. I invited doctor Kerry Kashall, who is 0:01:07.400 --> 0:01:11.760 an Australian GP and menopause specialist, educator and passionate advocate 0:01:11.800 --> 0:01:15.240 for women's hormonal health to the show. She's got more 0:01:15.280 --> 0:01:18.560 than twenty years of clinical experience and has dedicated much 0:01:18.560 --> 0:01:22.000 of her career to helping women better understand the powerful 0:01:22.080 --> 0:01:26.240 role hormones play in physical and mental health throughout the 0:01:26.280 --> 0:01:30.720 female life cycle. This is a really powerful resource and 0:01:30.800 --> 0:01:34.280 conversation that we can refer back to when we advance in. 0:01:34.280 --> 0:01:36.080 These stages of life. 0:01:36.240 --> 0:01:39.080 I think what I took away from this, and something 0:01:39.200 --> 0:01:41.240 very important, is that this is not a time in 0:01:41.319 --> 0:01:45.679 life to be fearful. We can completely thrive throughout this 0:01:45.760 --> 0:01:49.720 stage of our lives, and we simply need to empower 0:01:49.720 --> 0:01:54.280 ourselves and make the right steps forward to choosing a healthier, 0:01:54.800 --> 0:01:59.600 happier existence. We have listener questions embedded in this episode 0:01:59.640 --> 0:02:02.600 as well, so we find out all about that ballely 0:02:02.680 --> 0:02:06.880 fat nutrition, sleep, exhaustion, and all of those questions that 0:02:07.320 --> 0:02:10.560 so many listeners have had, and also the pathway to 0:02:10.639 --> 0:02:14.280 prescribing HRT and what that actually means. Make sure you 0:02:14.320 --> 0:02:16.680 listen all the way through this. So much in this 0:02:16.760 --> 0:02:19.520 for all of us. Please let me know your thoughts 0:02:19.600 --> 0:02:22.760 and any further questions that you may have around this. 0:02:22.960 --> 0:02:26.040 There's so much support out there, so the more education 0:02:26.520 --> 0:02:30.280 and knowledge that we give ourselves, the more of a 0:02:30.440 --> 0:02:34.000 wonderful position that we're here in enjoy this conversation with 0:02:34.120 --> 0:02:38.080 doctor Kerry Cashell, Doctor Kerry Cashall, welcome to the Things 0:02:38.080 --> 0:02:39.400 you Can't and Here Podcasts. 0:02:39.680 --> 0:02:41.639 Thank you very much for having me. It's a pleasure 0:02:41.680 --> 0:02:42.200 to be here. 0:02:43.160 --> 0:02:43.920 It is a pleasure. 0:02:44.000 --> 0:02:47.160 I think we're talking women's health, women's hormones, and it's 0:02:47.200 --> 0:02:50.800 a topic of conversation that I'm finding very important at 0:02:50.800 --> 0:02:54.320 the moment. Just the more conversations I seem to be having, 0:02:54.440 --> 0:02:56.280 the more questions I have, which is. 0:02:56.240 --> 0:03:00.480 Funny, right, it just opens up a whole worms. 0:03:00.680 --> 0:03:02.760 So I'm pleased you here because you are the expert, 0:03:02.760 --> 0:03:06.560 and you're breaking things down in such a way that 0:03:06.639 --> 0:03:09.760 it's very easy for us to understand, even if we 0:03:09.800 --> 0:03:11.760 don't have a medical background. So thank you for that. 0:03:11.800 --> 0:03:13.480 I thank you on behalf of all the women out 0:03:13.480 --> 0:03:17.200 there as well. I'm going to doctors and still don't 0:03:17.280 --> 0:03:19.280 have the answers to their questions. 0:03:19.600 --> 0:03:22.560 Yeah, that's such a common experience. It's been my journey too. 0:03:22.680 --> 0:03:25.200 You know, as I'm sure you've heard people say, you know, 0:03:25.240 --> 0:03:27.800 we're not trained in female health. We most of what 0:03:27.840 --> 0:03:32.240 we learn in our medical degree is based around male physiology, 0:03:32.680 --> 0:03:35.880 the physiology of a white seventy kilo male, not even 0:03:35.920 --> 0:03:38.840 all men. And and you know, we get taught a 0:03:38.840 --> 0:03:43.240 bit about reproductive medicine, so how to get pregnant, how 0:03:43.280 --> 0:03:45.560 to not get pregnant, how to deliver a baby. That's 0:03:45.960 --> 0:03:48.240 a bit about breasts, but for everything else in the 0:03:48.360 --> 0:03:51.080 female body, it's just the small version of men, which 0:03:51.120 --> 0:03:53.800 of course it isn't. So I've very much been on 0:03:53.840 --> 0:03:56.240 my own learning journey about female health, and I think 0:03:56.280 --> 0:04:00.520 that's partly why I maybe am reasonable at trans that, 0:04:00.560 --> 0:04:03.040 because I've been on my own learning journey, and I 0:04:03.040 --> 0:04:04.440 can tell you it would have been much easier for 0:04:04.440 --> 0:04:06.280 the first twenty years of medicine if I'd had that 0:04:06.400 --> 0:04:09.440 knowledge at the start, you knew, rather than two thirds 0:04:09.480 --> 0:04:11.560 of or whatever it is, half the way through my 0:04:11.600 --> 0:04:12.480 professional career. 0:04:12.560 --> 0:04:14.440 I think a lot of us women are making a 0:04:14.480 --> 0:04:16.960 lot more noise about it now, So I think people 0:04:16.960 --> 0:04:19.680 are standing up and listening, and I'd love to hear 0:04:19.720 --> 0:04:22.000 a bit about your journey, if you're willing to share it, actually, 0:04:22.080 --> 0:04:25.320 because I think that really allows us to see, you know, 0:04:25.400 --> 0:04:28.039 put ourselves in your shoes and hear how it unraveled 0:04:28.040 --> 0:04:28.240 for you. 0:04:28.760 --> 0:04:30.880 Yeah, yes, no, it is the great thing. Well, I 0:04:30.880 --> 0:04:34.720 think perrymenopause itself is the great unraveling or rebuilding or rewiring. 0:04:35.040 --> 0:04:37.880 So yeah, so I trained in the UK, trained in 0:04:37.880 --> 0:04:40.640 Scotland as a doctor. I had originally wanted to be 0:04:40.680 --> 0:04:42.840 a fashion designer. That has had always been what I 0:04:42.920 --> 0:04:45.280 wanted to do, and then did a last minute pivot 0:04:45.360 --> 0:04:49.800 before I left school after being inspired by a doctor 0:04:49.839 --> 0:04:52.320 who was working in Northern Ireland with my godmother who's 0:04:52.320 --> 0:04:54.640 also a doctor, learning because we had a lot of 0:04:54.640 --> 0:04:57.720 gunshot wounds back in the eighties in Northern Ireland. So 0:04:57.720 --> 0:05:00.560 she inspired me and off I went to medicine and yeah, 0:05:00.680 --> 0:05:02.920 did all the usual stuff that doctors do in training, 0:05:03.480 --> 0:05:06.560 and then came to Australia in twenty twelve. We fancied 0:05:06.600 --> 0:05:07.960 a change of scene, so I came out with my 0:05:08.040 --> 0:05:11.520 husband and two boys and settled into a lovely life 0:05:11.520 --> 0:05:16.000 in the northern beaches of Sydney. And I think I 0:05:16.040 --> 0:05:18.520 was probably and then I was moving into my forties myself. 0:05:19.360 --> 0:05:22.719 I became interested in a lot more holistic medicine. You know, 0:05:22.880 --> 0:05:25.400 I have had more a lot more time with my 0:05:25.480 --> 0:05:27.240 patients working in Australian than I would have done in 0:05:27.240 --> 0:05:29.240 the UK. It's very time pressured there, so you're just 0:05:29.320 --> 0:05:32.800 kind of far fighting the whole time, where As working 0:05:32.880 --> 0:05:35.080 in practice here I was able to get to know 0:05:35.160 --> 0:05:37.240 people a bit better. I was able to move away 0:05:37.240 --> 0:05:39.640 from just that pill for every ill and looking, you know, 0:05:39.720 --> 0:05:43.520 having more time to talk about lifestyle intervention, more preventative medicine. 0:05:44.040 --> 0:05:47.400 But it was really twenty twenty one when a patient 0:05:47.520 --> 0:05:50.760 came in and asked me to prescribe testosterone for her, 0:05:51.160 --> 0:05:54.920 and I had no idea how to prescribe testosterone. I 0:05:54.960 --> 0:05:57.400 think I had a vague idea it was a female hormone, 0:05:57.440 --> 0:05:59.760 but had certainly not ever considered it as a. 0:05:59.720 --> 0:06:01.000 Two in my toolbox. 0:06:01.320 --> 0:06:03.040 And she said, you need to go on up skill 0:06:03.480 --> 0:06:05.640 and here's a course you should do, and so she 0:06:05.680 --> 0:06:07.640 sent me off to do this course. And that was 0:06:07.760 --> 0:06:10.640 of course by Louise Newsoen, who had at that point 0:06:10.680 --> 0:06:13.920 already over two hundred podcasts. And then it was listening 0:06:13.920 --> 0:06:18.000 to all those patient stories in her podcasts and different specialists. 0:06:18.360 --> 0:06:20.520 I could see so many of my own patients and 0:06:20.520 --> 0:06:23.599 my own patients experiences in that, and I realized I 0:06:23.720 --> 0:06:26.440 really needed to go back and start from the beginning 0:06:26.720 --> 0:06:31.040 understand what it was that made women different to men, 0:06:31.080 --> 0:06:33.600 those assigned female birth different to those assigned male at 0:06:33.640 --> 0:06:36.960 birth in terms of hormones, and then that's gradually grown. 0:06:37.000 --> 0:06:39.919 I've got a real interest in how other parts of 0:06:39.960 --> 0:06:43.279 female physiology are different, which would be certainly connective tissue. 0:06:43.279 --> 0:06:45.760 You know, we're a bit more bendy, and that seems 0:06:45.760 --> 0:06:48.719 to impact you know, our immune system or nervous system differently. 0:06:48.800 --> 0:06:51.400 So we are we're the same, but we're also different, 0:06:51.480 --> 0:06:55.120 and we need a different set of rules, we need 0:06:55.160 --> 0:06:57.400 a different manual. So I realized that as a doctor, 0:06:57.440 --> 0:06:59.719 I've been trying to drive ferraris, which I think that's 0:06:59.720 --> 0:07:03.080 the of the ferraris, using a kind of old Ford manual. 0:07:03.240 --> 0:07:06.400 No offense to men, but male medicine is a lot simpler. 0:07:06.760 --> 0:07:09.520 You know, they don't have these hormonal changes. You know, women, 0:07:09.720 --> 0:07:11.920 you know, are living in a constant state of flux, 0:07:12.040 --> 0:07:15.160 you know, from the time they go into puberty, and 0:07:15.200 --> 0:07:20.800 it really doesn't settle down until you're through menopause, which 0:07:20.840 --> 0:07:22.840 is really postmenopause, and at that point, your you know, 0:07:22.880 --> 0:07:26.600 your sex hormones have stopped, you know, this ruler coaster journey, 0:07:26.600 --> 0:07:29.120 but they've flat lined, which has its own host of problems. 0:07:29.120 --> 0:07:32.600 Whereas men have testosterone, it doesn't changes a little bit 0:07:32.680 --> 0:07:35.360 in each twenty four hours, but it's overall it's pretty steady, 0:07:35.400 --> 0:07:38.080 and then it just gradually declines a little bit in 0:07:38.160 --> 0:07:40.800 a healthy man over the decades. And obviously men can 0:07:40.800 --> 0:07:43.000 reproduce until they die, so they have a very different 0:07:43.120 --> 0:07:47.200 experience of life to women. Women very different. 0:07:48.280 --> 0:07:51.559 Yeah, yeah, I Q you, and you know what, even 0:07:51.560 --> 0:07:54.240 though it's complicated being a woman, I still choose to 0:07:54.280 --> 0:07:54.640 be a woman. 0:07:54.640 --> 0:07:58.440 You never, Absolutely yes, it is a wonderful and wild ride. 0:07:58.640 --> 0:08:00.280 Do a couple of things that you said there that 0:08:00.320 --> 0:08:02.240 I loved, and one of them being, you know, the 0:08:02.320 --> 0:08:05.280 time that you give to patients when they come in. 0:08:05.760 --> 0:08:08.760 Very often we feel rushed and we feel like we 0:08:08.800 --> 0:08:11.680 can only bring up one thing while we're sitting in 0:08:11.720 --> 0:08:13.520 front of a doctor and we're in and out within 0:08:13.600 --> 0:08:15.480 ten minutes, and we're like, hang on a minute, I 0:08:15.520 --> 0:08:17.960 didn't say this, and I didn't say that. We get 0:08:17.960 --> 0:08:21.800 home and we think, what if I had mentioned this symptom. 0:08:21.520 --> 0:08:22.760 Or what if I hadn't mentioned that? 0:08:22.840 --> 0:08:26.120 Would that have changed what tests I got or what 0:08:26.560 --> 0:08:29.320 diagnosis I was given? And you know, I went to 0:08:29.440 --> 0:08:32.400 a woman's health specialist about six months ago, and there 0:08:32.440 --> 0:08:34.720 was such a beautiful process because I sat with a 0:08:34.880 --> 0:08:37.520 nurse before going in to see the doctor for about 0:08:37.520 --> 0:08:40.199 twenty five minutes, and she pretty much asked me every 0:08:40.240 --> 0:08:42.480 single question now I could possibly be asked. 0:08:42.960 --> 0:08:43.760 And then I went and. 0:08:43.679 --> 0:08:45.360 Saw the doctor and she reviewed all of that, and 0:08:45.400 --> 0:08:48.120 I thought that was absolutely amazing because I felt seen 0:08:48.240 --> 0:08:50.440 and I was able to actually get it all out. 0:08:50.600 --> 0:08:53.040 I was able to verbalize exactly how I was feeling 0:08:53.080 --> 0:08:55.880 without being a drag or without feeling like I was 0:08:56.679 --> 0:08:58.840 feeling sticks time exactly. 0:08:59.520 --> 0:09:02.160 So I think that's super important. I love that you 0:09:02.200 --> 0:09:02.480 do that. 0:09:03.160 --> 0:09:05.040 Yeah, no, I think I mean time is, you know, 0:09:05.200 --> 0:09:08.440 is such a fabulous tool. Like we are trained, especially 0:09:08.480 --> 0:09:14.040 as GPS, to let our patients speak. But often people 0:09:14.080 --> 0:09:17.079 are coming in, you know, they're anxious, they're worried. They also, 0:09:17.280 --> 0:09:19.640 especially women, always seem to say, I'm really sorry to 0:09:19.679 --> 0:09:21.440 bother you. I hate wasting your time. You know us 0:09:21.480 --> 0:09:23.920 you're kind of coming in going I probably shouldn't even 0:09:23.960 --> 0:09:26.640 be here. I'm like, there's people always sicker than me. It's, 0:09:26.720 --> 0:09:29.640 you know, terrible things that women do to diminish their 0:09:29.720 --> 0:09:32.920 right to decent care themselves because of our system but 0:09:33.320 --> 0:09:36.000 that time giving somebody a chance to speak, but also 0:09:36.080 --> 0:09:39.959 then exploring, you know, being more proactive and you're questioning 0:09:40.000 --> 0:09:42.760 and you know, looking at all the systems so that 0:09:42.840 --> 0:09:45.240 you can see, like what's going on with your mental 0:09:45.240 --> 0:09:48.480 health and what's happening with your gut, and what's happening 0:09:48.480 --> 0:09:50.680 with your periods and you know, I've done a few 0:09:50.720 --> 0:09:54.880 reels on Instagram just recently about how our system, the 0:09:54.960 --> 0:09:57.240 way it's structured, both in the in the US, in 0:09:57.280 --> 0:10:00.200 the UK and in Australia, really pushes people to do 0:10:00.280 --> 0:10:03.080 this kind of ten minute medicine, which doesn't really allow 0:10:03.120 --> 0:10:05.800 somebody to come in and talk through all their systems. 0:10:05.840 --> 0:10:08.080 They're all their symptoms, so you're often you're dealing with 0:10:08.160 --> 0:10:11.040 one or two symptoms at a time, and it doesn't 0:10:11.040 --> 0:10:13.720 give you the opportunity to go right these twenty symptoms 0:10:13.800 --> 0:10:15.880 or you know, in the case of perimenopause, there's hundreds 0:10:15.880 --> 0:10:19.160 of symptoms because you've got estergen receptors in every single cell. 0:10:19.000 --> 0:10:19.839 Of the body. 0:10:19.960 --> 0:10:21.920 You know, you could be going back and forward for 0:10:22.040 --> 0:10:24.719 you know, twenty years before you realize it's all perimenopause, 0:10:24.880 --> 0:10:27.000 or it's all a connective dishy disorder or it's all 0:10:27.000 --> 0:10:30.480 in other immune disease. So that time is although you 0:10:30.480 --> 0:10:31.839 can spend you need to spend more time at the 0:10:31.880 --> 0:10:35.400 beginning in the long term, even like over the next 0:10:35.600 --> 0:10:37.440 even over you know the period of the next year, 0:10:37.679 --> 0:10:40.040 you will have saved so much time you will have 0:10:40.080 --> 0:10:43.240 saved you know, whichever you know system it is in Australia, 0:10:43.240 --> 0:10:45.880 the medicare system, it's actually it's much more cost effective 0:10:45.960 --> 0:10:48.640 to spend that extra time at the beginning. Look at 0:10:48.679 --> 0:10:52.079 all the symptoms, see how they're connected. And often treatments 0:10:52.080 --> 0:10:54.920 are very similar for you know, different symptoms in terms 0:10:54.960 --> 0:10:57.200 of lifestyle. Yes, there's some differences in the drugs, but 0:10:57.240 --> 0:11:00.680 it's a much more efficient way. And you, as you 0:11:00.760 --> 0:11:05.760 experienced as a patient, you felt heard and you felt validated, 0:11:05.880 --> 0:11:08.959 and you know, it's a much more positive experience for 0:11:09.000 --> 0:11:11.920 book doctor and for a patient, I would say definitely. 0:11:12.000 --> 0:11:14.240 And you know, as patients we forget it's a business 0:11:14.320 --> 0:11:18.319 as well with GPS, and you know time is equals 0:11:18.679 --> 0:11:22.560 equals that money is money ultimately, so you know, at 0:11:22.600 --> 0:11:24.760 the same time, we do want to feel like our 0:11:24.840 --> 0:11:25.480 time is value. 0:11:25.480 --> 0:11:26.880 So I love how you've broken that down. 0:11:27.200 --> 0:11:29.680 I also what you said earlier, I loved in that 0:11:29.679 --> 0:11:32.480 that you're helping to educate other doctors. I think that's 0:11:32.520 --> 0:11:37.080 a huge thing because that isn't a standard education platform 0:11:37.120 --> 0:11:39.839 that people are getting, as you're saying, through medical school 0:11:39.880 --> 0:11:42.400 and learning about this at a deeper level. And you know, 0:11:42.440 --> 0:11:44.920 I've been watching your Instagram over the last couple of 0:11:45.080 --> 0:11:47.880 weeks and you know, just learning so much from that 0:11:48.000 --> 0:11:50.760 as well. And I think you know resources like that, 0:11:50.840 --> 0:11:54.800 and you're putting these scenarios out there that you know 0:11:55.480 --> 0:11:58.800 you've spoken to your patients about and us hearing sort 0:11:58.840 --> 0:12:01.600 of how you've worked or it's almost like detective work, 0:12:01.720 --> 0:12:04.680 trying to get to the bottom of exactly what that 0:12:04.720 --> 0:12:05.839 woman is going through. 0:12:06.280 --> 0:12:08.640 Yeah, very much so. And I mean it is also 0:12:09.200 --> 0:12:11.520 like we know in terms of how humans learn, we 0:12:11.640 --> 0:12:15.320 do learn by storytelling, so me telling and a scenario, 0:12:15.400 --> 0:12:17.839 and they are they're never exact scenarios because obviously the 0:12:17.960 --> 0:12:20.520 patient confidentiality always think I better said, this is not 0:12:20.600 --> 0:12:23.080 any one person. That's usually you know, e merge of 0:12:23.120 --> 0:12:27.520 different different themes. But we do learn by storytelling, and 0:12:27.640 --> 0:12:29.360 it is something we do in our medical training. But 0:12:29.400 --> 0:12:31.240 you know, it's much better for me to tell the 0:12:31.280 --> 0:12:33.200 story of the lady coming in, who's anxious, wonders if 0:12:33.200 --> 0:12:35.400 she's got ADHD, he's got heavy periods, and all the 0:12:35.400 --> 0:12:39.400 things that me saying perimenopause might make women anxious. It 0:12:39.559 --> 0:12:42.640 may also you know, it's it's much more real, and 0:12:42.760 --> 0:12:44.920 our brains like that. But you're right, you know a 0:12:44.960 --> 0:12:47.800 big part of why we set up Healthy Hormones was 0:12:47.880 --> 0:12:50.760 that we as a you know, as a group, realized 0:12:50.800 --> 0:12:53.760 we hadn't been trained, you know, we'd gone off and 0:12:53.760 --> 0:12:55.679 done our own training. We wanted to make that better 0:12:55.720 --> 0:12:59.000 for other clinicians, because most doctors want to do the 0:12:59.080 --> 0:13:02.160 best by their patient. But it's you know, we're also 0:13:02.360 --> 0:13:06.280 navigating a world of so much stuff that we need 0:13:06.280 --> 0:13:08.640 to learn and stay on top of, and we wanted 0:13:08.679 --> 0:13:11.120 to make it easy and accessible, which is why, you know, 0:13:11.320 --> 0:13:14.120 our clinical education on our Healthy Hormones it's an app 0:13:14.120 --> 0:13:16.000 that sits in your pocket. You know, as a clinician, 0:13:16.000 --> 0:13:18.480 you can type top and they've got marits in here, 0:13:18.520 --> 0:13:20.199 and she's having this problem. You know what shed to 0:13:20.240 --> 0:13:22.800 do now? Because a lot of this doesn't exist in 0:13:23.240 --> 0:13:25.760 textbooks or in guidelines because as you know, you know, 0:13:25.800 --> 0:13:30.480 we only spend one percent of research funding on female conditions. 0:13:30.480 --> 0:13:31.160 That aren't cancer. 0:13:31.200 --> 0:13:33.319 Six percent for cancer, but you know, ninety three percent 0:13:33.360 --> 0:13:36.400 of medical funding is not going to women. There's still 0:13:36.480 --> 0:13:42.000 menopause and perimenopause still get minimal service in medical training 0:13:42.040 --> 0:13:46.440 at medical school, postgraduate training still hardly anything, you know. 0:13:46.559 --> 0:13:49.680 So we're trained to treat men and women ear an 0:13:49.679 --> 0:13:54.160 afterthought and that really needs to change. But while it's changing, 0:13:55.040 --> 0:13:57.319 if it is even changing, that's where we're really wanting 0:13:57.360 --> 0:13:59.760 to improve it because it's a somewhat mikes life better 0:13:59.760 --> 0:14:04.360 for doctor's clinicians he treat and women themselves, you know, 0:14:04.480 --> 0:14:06.640 So that's a when for everybody. 0:14:07.000 --> 0:14:09.000 Exactly exactly right now. 0:14:09.360 --> 0:14:13.240 Last week I dropped an episode with a brilliant breast surgeon. 0:14:13.360 --> 0:14:16.960 Her name is doctor Yasmini Kevridge, and she operates in 0:14:17.440 --> 0:14:20.880 top Melbourne hospitals and we had a conversation there that 0:14:21.000 --> 0:14:23.760 has really stayed with me because I gave her a 0:14:23.840 --> 0:14:27.960 scenario as well. I'll explain the whole situation to you 0:14:28.000 --> 0:14:29.800 and I'd love to get your take on this. Actually, 0:14:29.880 --> 0:14:31.960 if anyone who hasn't listened, go back and listen to 0:14:31.960 --> 0:14:35.640 that episode after this one, because it's it's super important. 0:14:36.000 --> 0:14:38.760 Now the rates of breast cancer are one in seven 0:14:38.800 --> 0:14:41.400 women in Australia right now. And I gave her a 0:14:42.120 --> 0:14:45.600 situation where, because a lot of women are taking hormone 0:14:45.600 --> 0:14:50.120 replacement therapy at the moment, if a woman had presented 0:14:50.320 --> 0:14:53.600 with well, hadn't presented yet, but it was she had 0:14:53.760 --> 0:14:56.840 breast cancer but didn't know she had breast cancer and 0:14:56.880 --> 0:15:02.560 she started taking hormone replacement therapy, would that be detrimental 0:15:02.640 --> 0:15:06.800 to that situation or to that diagnosis or would that make. 0:15:06.680 --> 0:15:07.560 That cancer worse? 0:15:08.320 --> 0:15:12.760 And she insisted that it is super important for women 0:15:13.440 --> 0:15:17.160 to have a breast examination or a mammogram prior to 0:15:18.240 --> 0:15:22.400 having hormone replacement therapy, and because she's a breath surgeon, 0:15:22.440 --> 0:15:25.520 she always does that when she prescribes HRT. 0:15:26.720 --> 0:15:27.720 And then I did a poll. 0:15:27.880 --> 0:15:31.640 I did a poll on Instagram that bewildered me actually 0:15:31.680 --> 0:15:35.120 because I put it out to everyone who was following me, 0:15:35.400 --> 0:15:39.560 and I said, page's curious for those who are taking 0:15:39.720 --> 0:15:43.080 HRT at the moment, were you offered a breast examination 0:15:43.160 --> 0:15:46.560 or a mammogram before being prescribed HRT? And eighty nine 0:15:46.600 --> 0:15:49.440 percent of people said that they weren't. So I just 0:15:49.480 --> 0:15:53.480 want to get your perspective on this to see if 0:15:53.560 --> 0:15:55.600 you think it's necessary to see if that's something you 0:15:55.680 --> 0:15:58.960 do and just you know, open that conversation up again. 0:15:59.120 --> 0:16:01.720 Yeah, now that is such a good question, and yes, 0:16:01.760 --> 0:16:05.200 it is probably slightly surprising. What you find in your pool. 0:16:05.640 --> 0:16:09.840 Where I come from is that breast cancer and hormonal 0:16:09.840 --> 0:16:13.320 treatment of perimenopause and menopause are two separate things which 0:16:13.360 --> 0:16:17.560 obviously overlap because the woman there's an increased risk of 0:16:17.560 --> 0:16:20.000 breast cancer as women get older. So the majority of 0:16:20.000 --> 0:16:22.880 breast cancers are in women over fifty, and the majority 0:16:22.920 --> 0:16:25.800 of women who are taking hormone therapy are over fifty 0:16:25.840 --> 0:16:28.920 as well, So there's this overlap in terms of what 0:16:28.960 --> 0:16:31.080 we know from the data. Does I suppose one of 0:16:31.080 --> 0:16:34.560 the questions is does hormone therapy increase the risk of 0:16:34.640 --> 0:16:39.400 getting breast cancer? Does it promote the growth of breast cancer? 0:16:39.840 --> 0:16:42.440 So what we know from the largest control trials that 0:16:42.480 --> 0:16:45.800 we have, which would be the WHI the Woman's Health Initiative, 0:16:46.000 --> 0:16:48.320 which used a different type of use different types of 0:16:48.360 --> 0:16:51.120 hormones than we use today. So it used conjugated equine 0:16:51.200 --> 0:16:55.000 estrogen which is the horses estrogen, and synthetic progesterge majoxy 0:16:55.000 --> 0:16:57.720 progesto and acetate and then a group of women only 0:16:57.800 --> 0:17:01.920 use the estrogen, the equine eestrogen in the woman who 0:17:01.960 --> 0:17:07.239 took the combined hormone therapy, they saw those women, if 0:17:07.240 --> 0:17:10.280 they got breast cancer on hormone therapy, they did better, 0:17:10.720 --> 0:17:13.960 so they had better outcomes with their breast cancer and 0:17:14.000 --> 0:17:16.320 they had a reduced risk of death. But there was 0:17:16.520 --> 0:17:20.639 perhaps a small but there's it's still not strong that 0:17:20.680 --> 0:17:23.440 this was even statistically significant. There was perhaps a small 0:17:23.440 --> 0:17:27.560 increased risk of getting breast cancer in the woman taking 0:17:27.600 --> 0:17:31.760 combined hormone therapy, but that is in. 0:17:31.560 --> 0:17:33.480 These older, older drugs. 0:17:33.560 --> 0:17:36.880 So then they looked at women who only took estrogen 0:17:36.880 --> 0:17:40.639 because they'd had a hysterectomy. So standard practice at that 0:17:40.720 --> 0:17:42.919 time and still today is that you don't need progestogen 0:17:42.960 --> 0:17:45.480 if you don't have a uterus. The women who were 0:17:45.520 --> 0:17:49.159 taking estrogen had a reduced risk of getting breast cancer 0:17:49.240 --> 0:17:52.240 full stop. So women who only took estrogen reduced the 0:17:52.359 --> 0:17:55.360 risk of getting breast cancer by a quarter, and if 0:17:55.359 --> 0:17:57.919 they did get breast cancer, like the women on the 0:17:57.920 --> 0:18:02.040 combined hormone therapy, they also have better outcomes. So it 0:18:02.119 --> 0:18:06.760 looks like even in using these more synthetic forms combinate 0:18:06.840 --> 0:18:12.440 the progestogen perhaps, but even that wasn't actually hitting statistical significance. 0:18:12.560 --> 0:18:15.000 There is perhaps a small increased risk of an extra 0:18:15.080 --> 0:18:18.920 one case per thousand women getting breast cancer with estrogen. 0:18:19.000 --> 0:18:21.879 Your risk is actually reduced when it was estrogen on 0:18:21.920 --> 0:18:25.600 its own, and women in both groups, if they did 0:18:25.680 --> 0:18:29.880 get breast cancer, did better. So back in the nineties, 0:18:29.920 --> 0:18:32.359 about forty percent of women in the US, in the 0:18:32.520 --> 0:18:36.000 UK we're on hormone therapy. The risk of getting breast 0:18:36.000 --> 0:18:39.320 cancer was about one in twelve. Today it's in Australia 0:18:39.359 --> 0:18:41.400 it's about fifteen percent, so about one in six women 0:18:41.480 --> 0:18:43.520 are on HRT. But the risk of breast cancer has 0:18:43.600 --> 0:18:48.760 dramatically increased, So hormone therapy use has decreased, breast cancer 0:18:49.240 --> 0:18:54.160 risk has increased. So there is no study that shows 0:18:54.240 --> 0:18:58.719 that hormone therapy consistently increases the risk of breast cancer. 0:18:58.800 --> 0:19:01.359 What we have show is the estrogen on its own 0:19:01.800 --> 0:19:04.639 reduces breast cancer and that women who get breast cancer 0:19:04.680 --> 0:19:07.320 on h r T tend to do better. Then you 0:19:07.400 --> 0:19:10.119 look at then you look at breast cancer increasing, and 0:19:10.200 --> 0:19:13.760 it's critical that women in their forties, fifties, sixties, you know, 0:19:13.880 --> 0:19:17.280 get their breast screen So it's separate, but it doesn't 0:19:17.320 --> 0:19:19.800 mean if you're somebody you don't want a mammogrammar you 0:19:19.800 --> 0:19:23.320 don't want breastcraining. I wouldn't deny you hormone therapy on 0:19:23.320 --> 0:19:25.760 that basis, but I think it's a good idea to 0:19:25.800 --> 0:19:30.240 get breast screening as a woman who's getting older, because 0:19:30.359 --> 0:19:32.959 you know, there's your breast is subject to a lot 0:19:33.000 --> 0:19:36.720 of insults through life. It's tissue that is really affected 0:19:36.760 --> 0:19:39.520 by changing hormones, stress and life. 0:19:40.119 --> 0:19:42.000 The real risk factors for breast. 0:19:41.680 --> 0:19:48.359 Cancer are being female, sounds obvious, getting older, carrying excess weight, 0:19:49.040 --> 0:19:52.240 drinking alcohol, smoking, and then there's the things you can't 0:19:52.240 --> 0:19:54.359 do anything about, which is well being containing a boy, 0:19:54.359 --> 0:19:57.600 being a woman, or getting older. But your family history 0:19:57.720 --> 0:20:01.399 and if you have an inherited answer gene like the 0:20:01.400 --> 0:20:04.680 Blacker gene or Lynch syndrome, so really important that we 0:20:04.680 --> 0:20:06.840 look at family history, that we offer those women earlier 0:20:06.880 --> 0:20:10.360 brass screening, more enhanced bress screening, more regular brass screening, 0:20:10.359 --> 0:20:13.560 and certainly encouraging women to get genetic testing. But sort 0:20:13.600 --> 0:20:15.800 of seeing them is two things that are separate that 0:20:15.920 --> 0:20:17.760 do have an overlap, but we have to be really 0:20:17.800 --> 0:20:21.280 careful that we don't scare women, but equally that we 0:20:21.480 --> 0:20:26.399 encourage good screening. That kind of roundabout way of a 0:20:26.440 --> 0:20:27.640 complicated answer. 0:20:28.359 --> 0:20:30.440 Yeah, and that's the last thing I want to do too, 0:20:30.560 --> 0:20:34.240