1 00:00:01,360 --> 00:00:04,040 Speaker 1: Welcome to Wellness on MASS. I'm doctor Nicole Snaffire and 2 00:00:04,120 --> 00:00:07,160 Speaker 1: today's topic, well, it hits close to home. Today we're 3 00:00:07,160 --> 00:00:09,280 Speaker 1: going to dive into one of the most controversial and 4 00:00:09,360 --> 00:00:13,640 Speaker 1: misunderstood topics in medicine, form one replacement therapy for HRT. 5 00:00:14,040 --> 00:00:16,480 Speaker 1: As a woman. If you've been told that it's dangerous 6 00:00:16,600 --> 00:00:20,000 Speaker 1: or unnecessary, you're not alone. We all have. But it's 7 00:00:20,000 --> 00:00:22,200 Speaker 1: time to set the record straight because the science has 8 00:00:22,200 --> 00:00:24,880 Speaker 1: evolved and the stakes for women's health are too high 9 00:00:24,920 --> 00:00:27,600 Speaker 1: to ignore. And if you're a man listening to this podcast, 10 00:00:27,680 --> 00:00:29,520 Speaker 1: let me tell you, While you are not going to 11 00:00:29,560 --> 00:00:33,000 Speaker 1: go through perimenopause or menopause, I guarantee someone in your 12 00:00:33,080 --> 00:00:36,320 Speaker 1: orbit is going to because all women do. So you 13 00:00:36,400 --> 00:00:38,639 Speaker 1: might learn a thing or two by listening here. So 14 00:00:38,960 --> 00:00:41,320 Speaker 1: I would tune in because this will benefit you as well. 15 00:00:41,520 --> 00:00:44,720 Speaker 1: The reality is, in medical school, I was actually taught 16 00:00:44,720 --> 00:00:47,239 Speaker 1: that it was bad. But I'm going to age myself 17 00:00:47,360 --> 00:00:50,280 Speaker 1: just a little bit here. After nearly twenty years since 18 00:00:50,320 --> 00:00:53,440 Speaker 1: I have graduated from medical school, I've learned that on 19 00:00:53,440 --> 00:00:56,720 Speaker 1: my own, maybe to treat or to not treat peerimenopause 20 00:00:56,760 --> 00:00:59,720 Speaker 1: menopausal symptoms, it's not as black and white as maybe 21 00:00:59,720 --> 00:01:03,000 Speaker 1: we thought. And one of the most common reasons that 22 00:01:03,080 --> 00:01:06,680 Speaker 1: women who are undergoing breast cancer treatment. You know, oftentimes 23 00:01:06,680 --> 00:01:10,520 Speaker 1: they have surgery, radiation, sometimes chemotherapy. When that is all 24 00:01:10,560 --> 00:01:13,440 Speaker 1: said and done, if they have a hormone sensitive cancer, 25 00:01:13,640 --> 00:01:17,360 Speaker 1: oftentimes they will be offered an oral treatment to decrease 26 00:01:17,400 --> 00:01:19,840 Speaker 1: their risk of that cancer coming back. Well, that medication 27 00:01:20,319 --> 00:01:23,600 Speaker 1: the main side effect it essentially thrusts them into menopause 28 00:01:23,840 --> 00:01:26,920 Speaker 1: and women sometimes say the symptoms are far too much, 29 00:01:27,280 --> 00:01:29,520 Speaker 1: they can't deal with it, and they're going to stop 30 00:01:29,560 --> 00:01:33,160 Speaker 1: taking the medication. Now, as a young doctor, I was 31 00:01:33,200 --> 00:01:36,160 Speaker 1: shocked that women would make this choice. They know the 32 00:01:36,240 --> 00:01:39,399 Speaker 1: risk of their cancer coming back is slightly increased if 33 00:01:39,440 --> 00:01:42,480 Speaker 1: they don't take that medication, But for them, what is 34 00:01:42,520 --> 00:01:44,959 Speaker 1: the life worth living if they are unhappy, if they 35 00:01:45,000 --> 00:01:47,640 Speaker 1: don't feel well. The older I have gotten, the more 36 00:01:47,680 --> 00:01:49,880 Speaker 1: I have begun to understand that it's not really all 37 00:01:49,920 --> 00:01:52,920 Speaker 1: about risk reduction when it comes to life, but quality 38 00:01:52,960 --> 00:01:56,960 Speaker 1: of life being lived is equally as important. Sometimes physicians 39 00:01:57,000 --> 00:01:59,960 Speaker 1: forget this. As patients, you have to be your advocate. 40 00:02:00,240 --> 00:02:02,480 Speaker 1: You have to talk to them about your quality of life, 41 00:02:02,520 --> 00:02:05,120 Speaker 1: because if you're not enjoying life, we all only get 42 00:02:05,160 --> 00:02:07,800 Speaker 1: one opportunity on this earth. You have to make the 43 00:02:07,840 --> 00:02:10,160 Speaker 1: best of it. And one of the most frequently asked 44 00:02:10,280 --> 00:02:12,760 Speaker 1: questions that I get, whether it's from a patient coming 45 00:02:12,760 --> 00:02:15,880 Speaker 1: in from a routine mammogram or I'm giving a speech 46 00:02:15,960 --> 00:02:18,680 Speaker 1: and I take questions from the audience, people want to 47 00:02:18,760 --> 00:02:22,440 Speaker 1: know what's my personal opinion on hormone replacement therapy for 48 00:02:22,600 --> 00:02:25,680 Speaker 1: perimenopausal symptoms. And when I tell them I support it, 49 00:02:26,000 --> 00:02:28,840 Speaker 1: most are shocked. But I've gotten confident in my ability 50 00:02:28,880 --> 00:02:32,200 Speaker 1: to declare my support for HRT because I refuse to 51 00:02:32,320 --> 00:02:35,400 Speaker 1: let twenty year old, flawed data disrupt the lives of 52 00:02:35,480 --> 00:02:39,400 Speaker 1: so many women, myself included. And truthfully, it wasn't until 53 00:02:39,480 --> 00:02:42,640 Speaker 1: my own personal experience that I decided to do a 54 00:02:42,680 --> 00:02:45,280 Speaker 1: deep dive into the data. That is what I'm here 55 00:02:45,320 --> 00:02:48,080 Speaker 1: to share with you. So last year I started having 56 00:02:48,080 --> 00:02:51,280 Speaker 1: some symptoms of my own. They're very vague, but one 57 00:02:51,320 --> 00:02:54,960 Speaker 1: thing was I got a migraine. I've never had migraines. 58 00:02:55,040 --> 00:02:57,320 Speaker 1: I'm not a headache person. I had them a little 59 00:02:57,400 --> 00:02:59,680 Speaker 1: bit when I was a teenager, but that was it. 60 00:02:59,720 --> 00:03:02,480 Speaker 1: As an adult, I don't get headaches, it's not my thing. 61 00:03:02,680 --> 00:03:05,160 Speaker 1: But I got a migraine, and then on top of that, 62 00:03:05,320 --> 00:03:08,280 Speaker 1: I just wasn't feeling well. I was feeling a little tired, 63 00:03:08,360 --> 00:03:11,160 Speaker 1: a little achy. I have a very busy life. It's 64 00:03:11,240 --> 00:03:13,480 Speaker 1: kind of attributing it all to that. I also have 65 00:03:13,520 --> 00:03:16,600 Speaker 1: an autoimmune disease. So I immediately thought, oh, no, my 66 00:03:16,639 --> 00:03:20,400 Speaker 1: autoimmune disease is progressing. Turns out my ovaries are just 67 00:03:20,440 --> 00:03:22,800 Speaker 1: taking a break. It may be a permanent break. I 68 00:03:22,800 --> 00:03:26,240 Speaker 1: don't know. But I went to my physicians and I 69 00:03:26,320 --> 00:03:28,480 Speaker 1: talked to them and I said, something's not going on 70 00:03:28,560 --> 00:03:31,480 Speaker 1: with me, or something's not right with me. Thankfully, my 71 00:03:31,560 --> 00:03:34,880 Speaker 1: rheumatologist said, we don't think it's the autoimmune disease. I 72 00:03:34,960 --> 00:03:37,520 Speaker 1: was also having some other symptoms that I talked to 73 00:03:37,560 --> 00:03:42,240 Speaker 1: my gynecologists about, specifically being dysperunia. You can google what 74 00:03:42,280 --> 00:03:45,800 Speaker 1: that means, but essentially means discomfort during intercourse. And so 75 00:03:46,160 --> 00:03:48,840 Speaker 1: I had the foresight of, you know, the only other 76 00:03:48,880 --> 00:03:51,920 Speaker 1: time I have felt this is right after I've had babies. 77 00:03:52,120 --> 00:03:54,480 Speaker 1: And what happens right after you have babies, Well, your 78 00:03:54,480 --> 00:03:57,680 Speaker 1: hormones drop immediately. So something inside of me was telling 79 00:03:57,720 --> 00:04:00,520 Speaker 1: me this could all be related to hormones drop because 80 00:04:00,520 --> 00:04:02,800 Speaker 1: I've had free babies. I have felt this way three 81 00:04:02,800 --> 00:04:05,640 Speaker 1: times before and it feels kind of similar, and that's 82 00:04:05,680 --> 00:04:08,000 Speaker 1: what happened. Yep, my o raees are on a break now. 83 00:04:08,040 --> 00:04:10,160 Speaker 1: I'm not going to say I'm in menopause. I'm for 84 00:04:10,200 --> 00:04:13,480 Speaker 1: anybody keeping track, I am pretty young to be in menopause. 85 00:04:13,480 --> 00:04:15,760 Speaker 1: I am in my early forties, but some people do 86 00:04:15,840 --> 00:04:19,000 Speaker 1: go into menopause early menopause, even late thirties, early forties. 87 00:04:19,240 --> 00:04:22,240 Speaker 1: But my hormones are down, and so I wanted to 88 00:04:22,279 --> 00:04:26,720 Speaker 1: talk about options. My gynecologists actually brought up HRT, and 89 00:04:27,080 --> 00:04:29,640 Speaker 1: immediately I got a little bit nervous, and that's when 90 00:04:29,680 --> 00:04:32,839 Speaker 1: I said, I need to do my own research to 91 00:04:32,839 --> 00:04:35,760 Speaker 1: figure out what's my opinion on HRT. Is it right 92 00:04:35,800 --> 00:04:37,680 Speaker 1: for me? What are the risks and benefits for me 93 00:04:37,720 --> 00:04:41,000 Speaker 1: as an individual? Because not one person is the same 94 00:04:41,040 --> 00:04:43,479 Speaker 1: as the other. We're all different. So we have to 95 00:04:43,520 --> 00:04:45,839 Speaker 1: go back in the way back machine to why we 96 00:04:45,920 --> 00:04:49,880 Speaker 1: have this group think of HRT being bad actually exists. 97 00:04:50,080 --> 00:04:53,320 Speaker 1: In two thousand and two, the largest studies ever done 98 00:04:53,440 --> 00:04:58,120 Speaker 1: on postmenopausal women, called the Women's Health Initiative, was terminated early, 99 00:04:58,520 --> 00:05:02,279 Speaker 1: and this sent shockwaves all across the medical community. The 100 00:05:02,320 --> 00:05:06,880 Speaker 1: study actually linked hormone therapy to breast cancer, stroke, heart disease, 101 00:05:07,200 --> 00:05:09,760 Speaker 1: and even blood flots, and the media headlines they were 102 00:05:09,839 --> 00:05:14,960 Speaker 1: terrifying and subsequently hormone use by women plummeted. Here's the truth. 103 00:05:15,200 --> 00:05:19,280 Speaker 1: The study largely flawed and has nothing to do with 104 00:05:19,360 --> 00:05:22,039 Speaker 1: what we are talking about here over twenty years later, 105 00:05:22,279 --> 00:05:24,880 Speaker 1: and I'll tell you why these people were more afraid 106 00:05:24,920 --> 00:05:27,720 Speaker 1: of the clickbit headlines than to spend time to really 107 00:05:27,760 --> 00:05:30,840 Speaker 1: interrogate the whole validity of the study and dive deep 108 00:05:30,920 --> 00:05:33,000 Speaker 1: into why it was even stopped early to begin with. 109 00:05:33,160 --> 00:05:36,080 Speaker 1: So this large study took groups of women and they 110 00:05:36,080 --> 00:05:38,520 Speaker 1: separated them to two main groups. One group of women 111 00:05:38,720 --> 00:05:43,520 Speaker 1: had combined estrogen progestrum, the other one had just estrogen. Originally, 112 00:05:43,560 --> 00:05:45,400 Speaker 1: the study was supposed to have eight and a half 113 00:05:45,480 --> 00:05:48,719 Speaker 1: years of follow up, but after a statistical signal was 114 00:05:48,760 --> 00:05:52,200 Speaker 1: seen after a little over five years, they stopped the study. 115 00:05:52,520 --> 00:05:55,560 Speaker 1: The decision was based on what's called a statistical threshold 116 00:05:55,880 --> 00:05:58,360 Speaker 1: and it was crossed for what they called the global 117 00:05:58,400 --> 00:06:02,040 Speaker 1: index risk, which include voted. They saw an increased risk 118 00:06:02,120 --> 00:06:04,600 Speaker 1: of breast cancer, stroke, card gacks employed cloths like I 119 00:06:04,640 --> 00:06:09,240 Speaker 1: already mentioned, but the absolute risk was very small. For example, 120 00:06:09,400 --> 00:06:12,440 Speaker 1: the increased risk of breast cancer was eight additional cases 121 00:06:12,520 --> 00:06:16,320 Speaker 1: per ten thousand women per year. Statistically speaking, that is 122 00:06:16,360 --> 00:06:18,440 Speaker 1: a very small but for those eight women who got 123 00:06:18,440 --> 00:06:22,200 Speaker 1: breast cancer, that's not small at all. Right, here's the issue. 124 00:06:22,279 --> 00:06:26,040 Speaker 1: The average age of women in the study was sixty three. 125 00:06:26,120 --> 00:06:29,360 Speaker 1: This is long past menopause. The average age for women 126 00:06:29,400 --> 00:06:32,680 Speaker 1: to go into menopause is fifty two, meaning from early 127 00:06:32,760 --> 00:06:36,760 Speaker 1: forties to early sixties and everywhere in between. That's when 128 00:06:36,839 --> 00:06:40,320 Speaker 1: most women go through menopause. If the average age of 129 00:06:40,320 --> 00:06:42,920 Speaker 1: the woman in the study was sixty three, that means 130 00:06:43,000 --> 00:06:47,359 Speaker 1: they were sampling fifties through their seventies. And this is 131 00:06:47,440 --> 00:06:51,440 Speaker 1: not representative of the typical woman starting HRT, who should 132 00:06:51,480 --> 00:06:53,920 Speaker 1: be in her forties or fifties. And by the way, 133 00:06:54,080 --> 00:06:57,719 Speaker 1: being a woman and getting older are independent risk factors 134 00:06:57,839 --> 00:07:00,760 Speaker 1: for breast cancer. So the older they are, they already 135 00:07:00,760 --> 00:07:04,320 Speaker 1: have a higher risk of breast cancer just by age alone. 136 00:07:04,440 --> 00:07:07,960 Speaker 1: And most participants in the study had underlying risk factors 137 00:07:08,080 --> 00:07:12,160 Speaker 1: like obesity and cardiovascular disease. And by the way, obesity 138 00:07:12,240 --> 00:07:16,120 Speaker 1: increases your risk of breast cancer, blood clots, strokes, as 139 00:07:16,200 --> 00:07:20,000 Speaker 1: cardiovascular disease does, so it wasn't a great sample set, 140 00:07:20,400 --> 00:07:23,880 Speaker 1: and it certainly was not representative of the women were 141 00:07:23,920 --> 00:07:28,280 Speaker 1: talking about who might benefit from hormone replacement therapy. Again, 142 00:07:28,600 --> 00:07:31,760 Speaker 1: younger women, women who are actively trying to keep their 143 00:07:31,800 --> 00:07:34,640 Speaker 1: health in check. And the problem wasn't just who they 144 00:07:34,640 --> 00:07:38,160 Speaker 1: gave the hormones to, but it was also the hormones 145 00:07:38,200 --> 00:07:40,200 Speaker 1: that they gave to these women. So first I want 146 00:07:40,240 --> 00:07:42,440 Speaker 1: to talk about the two arms. The one arm with 147 00:07:42,560 --> 00:07:45,480 Speaker 1: the estrogen and progesterone because you have to have that 148 00:07:45,560 --> 00:07:49,120 Speaker 1: balance there, but the other arm just had estrogen. But 149 00:07:49,200 --> 00:07:52,720 Speaker 1: it's a very specific caveat. Only women who have had 150 00:07:52,760 --> 00:07:57,240 Speaker 1: a hysterectomy or surgical removal of their uterus can have 151 00:07:57,720 --> 00:08:01,280 Speaker 1: estrogen alone. Now why is that, Well, it is an 152 00:08:01,400 --> 00:08:06,360 Speaker 1: unequivocal truth that estrogen increases your risk of endometrial cancer. 153 00:08:06,560 --> 00:08:10,480 Speaker 1: Endometrial cancer is a cancer that develops in the internal 154 00:08:10,480 --> 00:08:14,400 Speaker 1: lining of your uterus. You have to have progesterone to 155 00:08:14,560 --> 00:08:17,960 Speaker 1: balance estrogen or else you will have an increased risk 156 00:08:18,240 --> 00:08:21,760 Speaker 1: of uterine cancer. So again, the arm could only have 157 00:08:21,800 --> 00:08:25,080 Speaker 1: been women who had estrogen if their uters was removed. 158 00:08:25,360 --> 00:08:29,000 Speaker 1: But the estrogens that they used in this study is 159 00:08:29,040 --> 00:08:33,720 Speaker 1: specifically called conjugated equin estrogen and it's derived from pregnant 160 00:08:33,760 --> 00:08:37,040 Speaker 1: horse urine. Yes, you heard me right, Sorry, ladies, science 161 00:08:37,080 --> 00:08:40,800 Speaker 1: isn't always sexy. Yeah. Did you know there's a diabetes 162 00:08:40,880 --> 00:08:44,640 Speaker 1: medication that's actually derived from the saliva of a HeLa monster, 163 00:08:44,880 --> 00:08:47,440 Speaker 1: And there's a common blood thinner that was derived from 164 00:08:47,600 --> 00:08:51,840 Speaker 1: rat poison alas this or how medications are. Some of 165 00:08:51,840 --> 00:08:54,480 Speaker 1: them are medical marvels and some of them are not 166 00:08:54,600 --> 00:08:57,880 Speaker 1: so much more coming up on Wellness Unmasked with doctor 167 00:08:57,960 --> 00:09:04,200 Speaker 1: Nicol Sapphire. But the thing with the conjugated equin estrogen 168 00:09:04,640 --> 00:09:09,199 Speaker 1: is that it doesn't parallel the estrogen that our body makes, 169 00:09:09,440 --> 00:09:12,120 Speaker 1: and it is very different from estrogens that are available today. 170 00:09:12,520 --> 00:09:16,719 Speaker 1: These conjugated estrogens, they're a mixture of multiple different estrogens. 171 00:09:17,000 --> 00:09:20,760 Speaker 1: Some are human identical and some are not. Metabolism is 172 00:09:20,880 --> 00:09:24,120 Speaker 1: very unpredictable. And if the estrogen wasn't bad enough, the 173 00:09:24,160 --> 00:09:27,360 Speaker 1: progesterone that they used is a synthetic progesterone that in 174 00:09:27,640 --> 00:09:31,320 Speaker 1: subsequent research after that big study, it's been proven to 175 00:09:31,559 --> 00:09:36,439 Speaker 1: negatively impact lipid profiles, your mood, rest tissue, and has 176 00:09:36,480 --> 00:09:39,439 Speaker 1: also been shown to increase the risk of clotting and inflammation. 177 00:09:39,800 --> 00:09:43,880 Speaker 1: So these hormones were not good. And furthermore, they were 178 00:09:43,920 --> 00:09:47,680 Speaker 1: taking orally. What's the problem with taking these orally? Well, 179 00:09:47,720 --> 00:09:51,719 Speaker 1: it undergoes what's called first pass liver metabolism, and that 180 00:09:51,800 --> 00:09:55,360 Speaker 1: means that you consume it and now the liver metabolizes it. 181 00:09:55,400 --> 00:09:59,840 Speaker 1: But during that metabolism it increases the blood clotting factors 182 00:10:00,040 --> 00:10:03,760 Speaker 1: and what's called a C reactive protein, which creates inflammation. 183 00:10:04,200 --> 00:10:09,120 Speaker 1: So these hormones were bad idea in an older, non representative, 184 00:10:09,240 --> 00:10:12,840 Speaker 1: higher risk population. This is why I don't like the study. Now, 185 00:10:12,880 --> 00:10:15,800 Speaker 1: if we fast forward to what we have available today, 186 00:10:16,080 --> 00:10:19,600 Speaker 1: most commonly, you have a seventeen beta estrogyl. This is 187 00:10:19,640 --> 00:10:24,400 Speaker 1: a bioidentical estrogen that mirrors the body's natural estigen. On 188 00:10:24,440 --> 00:10:27,480 Speaker 1: top of that, you don't take it orally. It's available 189 00:10:27,520 --> 00:10:32,000 Speaker 1: in transdermal patches, gels, brays, and this avoids deliver metabolism 190 00:10:32,520 --> 00:10:36,040 Speaker 1: and therefore has a lower clouding and inflammation risk. Additionally, 191 00:10:36,200 --> 00:10:39,960 Speaker 1: we have what's called micronized progesterone. It's a bioidentical just 192 00:10:40,000 --> 00:10:42,520 Speaker 1: like your body makes, and it's safer for the breast 193 00:10:42,520 --> 00:10:46,439 Speaker 1: tissue and the cardiovascular profile and has also been associated 194 00:10:46,480 --> 00:10:49,400 Speaker 1: with fewer mood side effects and better sleep. And as 195 00:10:49,440 --> 00:10:52,360 Speaker 1: someone who diagnoses breast cancer every day, it's really important 196 00:10:52,360 --> 00:10:57,360 Speaker 1: for me that this transdermal estragile and the micronized progesterone 197 00:10:57,360 --> 00:11:00,800 Speaker 1: combo in a big study did not show increased breast 198 00:11:00,800 --> 00:11:04,920 Speaker 1: cancer risk in later observational studies. Great news. So while 199 00:11:04,960 --> 00:11:09,320 Speaker 1: all the headlines said perimenopausal menopausal hormones are bad, you 200 00:11:09,360 --> 00:11:12,440 Speaker 1: should not consider hormone replacement therapy, it's not that the 201 00:11:12,520 --> 00:11:16,240 Speaker 1: hormones are dangerous. Maybe the hormones used in that study, 202 00:11:16,520 --> 00:11:19,000 Speaker 1: but it was really just that it's the wrong hormones 203 00:11:19,000 --> 00:11:21,760 Speaker 1: were given the wrong way to the wrong people, and 204 00:11:21,880 --> 00:11:26,360 Speaker 1: those results were unfairly applied to everyone. Today's hormone options 205 00:11:26,400 --> 00:11:29,560 Speaker 1: are safer, smarter, and they're tailored to the unique risk profile. 206 00:11:29,880 --> 00:11:32,920 Speaker 1: You can go to your gynecologists or your precision medicine 207 00:11:32,960 --> 00:11:35,640 Speaker 1: doctor and they can take a blood test. They can 208 00:11:35,640 --> 00:11:38,360 Speaker 1: see exactly where your markers are, what your levels at. 209 00:11:38,559 --> 00:11:40,520 Speaker 1: It's not a one size fits all. They can give 210 00:11:40,559 --> 00:11:42,640 Speaker 1: you what you need to make you feel better. We 211 00:11:42,679 --> 00:11:44,880 Speaker 1: have learned from the past and we cannot let it 212 00:11:44,920 --> 00:11:48,160 Speaker 1: paralyze the present. Absolutely not. And if we fast forward 213 00:11:48,160 --> 00:11:51,439 Speaker 1: to today, many re analysis and newer studies, they've all 214 00:11:51,480 --> 00:11:54,480 Speaker 1: flipped the script. We now know that when started within 215 00:11:54,600 --> 00:11:57,720 Speaker 1: ten years of menopause or before the age of sixty, 216 00:11:58,360 --> 00:12:02,920 Speaker 1: HRT can actually read use all cause mortality, meaning reduce 217 00:12:03,160 --> 00:12:06,680 Speaker 1: everything essentially that can cause death, lowers heart disease risk, 218 00:12:06,960 --> 00:12:11,360 Speaker 1: improves bone help, stabilizes mood, improves our sleep, protects our 219 00:12:11,360 --> 00:12:14,959 Speaker 1: brain health, our cognitive function, decreases our risk of dementia, 220 00:12:15,040 --> 00:12:18,120 Speaker 1: and most importantly, it's making women feel better and is 221 00:12:18,200 --> 00:12:21,200 Speaker 1: doing it safely. So, like I said, every woman is 222 00:12:21,280 --> 00:12:25,160 Speaker 1: going to face perimenopause and menopause. Some women really struggle 223 00:12:25,200 --> 00:12:28,520 Speaker 1: through it, have severe symptoms. Other women have no idea 224 00:12:28,559 --> 00:12:30,920 Speaker 1: it's happening, and the only reason they know it's happening 225 00:12:31,000 --> 00:12:33,320 Speaker 1: is because they no longer get a period. But here's 226 00:12:33,360 --> 00:12:36,320 Speaker 1: the issue. Let's talk about what happens if you don't 227 00:12:36,360 --> 00:12:40,120 Speaker 1: treat the natural estrogen loss that happens with age. Estrogen 228 00:12:40,280 --> 00:12:43,200 Speaker 1: isn't just about getting your periods, menstrual cycle and getting 229 00:12:43,240 --> 00:12:46,920 Speaker 1: pregnant and all that. It also protects our bones, our brains, 230 00:12:47,080 --> 00:12:50,680 Speaker 1: our blood vessels, our skin, and our mood. Without it, 231 00:12:50,880 --> 00:12:55,840 Speaker 1: women are significantly at higher risk of osteoporosis and bone fractures, 232 00:12:55,960 --> 00:12:58,959 Speaker 1: heart disease. Remember that's the number one killer of women, 233 00:12:59,200 --> 00:13:03,400 Speaker 1: not cancer, cognitive decline in Alzheimer's disease. Women are more 234 00:13:03,480 --> 00:13:06,440 Speaker 1: likely to get Alzheimer's. Why is that because when you 235 00:13:06,480 --> 00:13:09,040 Speaker 1: have a decrease in estrogen, we have an increased risk 236 00:13:09,080 --> 00:13:13,440 Speaker 1: of Alzheimer's. Anxiety, depression, poor sleep, painful intercourse. All of 237 00:13:13,480 --> 00:13:16,640 Speaker 1: this can go along with a decrease in estrogen. It's 238 00:13:16,640 --> 00:13:19,560 Speaker 1: important to talk to your doctor about replacing that, not 239 00:13:19,760 --> 00:13:22,320 Speaker 1: just because you want to avoid hot flashes. Some people, 240 00:13:22,480 --> 00:13:24,920 Speaker 1: some women, actually take it as a medal of honor 241 00:13:25,080 --> 00:13:27,960 Speaker 1: or badge of whatever, saying, Oh, it's not that bad, 242 00:13:28,000 --> 00:13:30,760 Speaker 1: I can muscle through it. But should we be muscling 243 00:13:30,800 --> 00:13:33,440 Speaker 1: through it? It's not weakness going to your doctor and 244 00:13:33,480 --> 00:13:36,720 Speaker 1: asking for these hormones. Okay, I understand we all like 245 00:13:36,760 --> 00:13:39,640 Speaker 1: to muscle through things. I am guilty of it myself, 246 00:13:39,880 --> 00:13:42,880 Speaker 1: But is so much more estrogen is needed for so 247 00:13:43,000 --> 00:13:45,760 Speaker 1: many more things. As we get older, our bones just 248 00:13:45,840 --> 00:13:49,600 Speaker 1: stop mineralizing. We get weaker. You see those little old 249 00:13:49,640 --> 00:13:52,720 Speaker 1: women who are slumped over and their backs are curved, 250 00:13:52,760 --> 00:13:55,480 Speaker 1: and they have spinal fractures or broken hip and all 251 00:13:55,480 --> 00:13:58,800 Speaker 1: these other things that have a huge risk of mortality 252 00:13:59,160 --> 00:14:02,200 Speaker 1: that is because of estrogen loss. Now, of course HRT 253 00:14:02,400 --> 00:14:05,280 Speaker 1: it's not for everyone. Not everyone can go out and 254 00:14:05,440 --> 00:14:09,160 Speaker 1: just start taking these medications. Women with active breast cancer, 255 00:14:09,400 --> 00:14:12,760 Speaker 1: untreated blood clots, liver disease. As I said, women who 256 00:14:12,800 --> 00:14:14,880 Speaker 1: have a uterus, you can't just go out and start 257 00:14:14,880 --> 00:14:17,720 Speaker 1: taking estrogen. One way to offset that and balance the 258 00:14:17,880 --> 00:14:21,600 Speaker 1: estrogen is to have a progesterone ID or take a 259 00:14:21,640 --> 00:14:24,680 Speaker 1: balance take that micronized progesterone. You can talk to your 260 00:14:24,720 --> 00:14:28,640 Speaker 1: doctor about it. Women with active breast cancer, untreated blood clots, 261 00:14:28,800 --> 00:14:31,720 Speaker 1: or liver disease, unfortunately, may need to take a different 262 00:14:31,760 --> 00:14:34,560 Speaker 1: approach to manage some of these symptoms and reduce their 263 00:14:34,640 --> 00:14:38,000 Speaker 1: risk of illness because taking estrogen can have negative effects 264 00:14:38,080 --> 00:14:40,800 Speaker 1: on them. That's why we individualize care. This is not 265 00:14:40,880 --> 00:14:43,880 Speaker 1: a one size fits all conversation. And even if you 266 00:14:44,080 --> 00:14:47,080 Speaker 1: can take HRT or you can't take HRT, there are 267 00:14:47,120 --> 00:14:49,160 Speaker 1: still a lot of other things that you should be 268 00:14:49,280 --> 00:14:53,120 Speaker 1: doing in everyday life in addition to HRT to live 269 00:14:53,160 --> 00:14:55,680 Speaker 1: your healthiest life. One of the biggest things we are 270 00:14:55,760 --> 00:14:58,640 Speaker 1: what we eat. We have to focus on anti inflammatory 271 00:14:58,680 --> 00:15:01,440 Speaker 1: and nutrition. I didn't foocus on this in college. In 272 00:15:01,440 --> 00:15:04,560 Speaker 1: medical school. The only time that I really started learning 273 00:15:04,600 --> 00:15:07,760 Speaker 1: about what I consume and what my family consumes is 274 00:15:07,800 --> 00:15:10,640 Speaker 1: after I was diagnosed with an autoimmune disease. So anti 275 00:15:10,640 --> 00:15:14,640 Speaker 1: inflammatory nutrition are foods that are high in ovegas threes, 276 00:15:14,960 --> 00:15:19,520 Speaker 1: like fish, specifically salmon, big leafy greens, berries. You can 277 00:15:19,560 --> 00:15:21,720 Speaker 1: google all the things you want. You can follow me 278 00:15:21,760 --> 00:15:24,200 Speaker 1: on Instagram. I like to do a lot of cooking there. 279 00:15:24,440 --> 00:15:27,480 Speaker 1: I'm also a big advocate for natural herbs. That's why 280 00:15:27,520 --> 00:15:31,200 Speaker 1: I created drop our X, the liquid nutraceutical line, because 281 00:15:31,240 --> 00:15:36,360 Speaker 1: I heavily support people taking like Trestrius, tribulus tumoric makaru 282 00:15:36,600 --> 00:15:40,600 Speaker 1: oshul ganda. These can help with everything from hot flashes 283 00:15:40,680 --> 00:15:45,280 Speaker 1: to sleep, to sexual desire and everything in between, decreasing inflammation, 284 00:15:45,560 --> 00:15:48,560 Speaker 1: all of that stuff. It's essential that we take magnesium 285 00:15:48,560 --> 00:15:51,880 Speaker 1: and vitamin D to keep our bones strong, and also 286 00:15:51,920 --> 00:15:55,040 Speaker 1: it helps with our mood, sleep, hydreene, stress management, all 287 00:15:55,080 --> 00:15:57,160 Speaker 1: of those things. I know you're kind of like, yeah, yeah, 288 00:15:57,200 --> 00:15:59,400 Speaker 1: we've heard this all before, but the reality is if 289 00:15:59,440 --> 00:16:02,240 Speaker 1: you are not geting quality sleep, you are not going 290 00:16:02,280 --> 00:16:04,320 Speaker 1: to be fine during the day. It doesn't matter if 291 00:16:04,360 --> 00:16:06,720 Speaker 1: you can just power through it. Your body and your 292 00:16:06,760 --> 00:16:10,040 Speaker 1: brain need that reset every single night. You should be 293 00:16:10,040 --> 00:16:13,240 Speaker 1: prioritizing your sleep just as much as you're prioritizing getting 294 00:16:13,280 --> 00:16:16,520 Speaker 1: your maniogram or your colonoscy or anything else, because sleep 295 00:16:16,560 --> 00:16:20,880 Speaker 1: is essential and stress management. So many disease, cancer, cardiovash, 296 00:16:20,920 --> 00:16:24,720 Speaker 1: goo disease are all linked to stress, the high cortisol levels, 297 00:16:25,000 --> 00:16:26,760 Speaker 1: and as we go through menopause and we have all 298 00:16:26,800 --> 00:16:30,600 Speaker 1: these hormonal fluctuations, managing our cortisol is a big deal. 299 00:16:30,880 --> 00:16:33,720 Speaker 1: One thing you can do, decrease your stress level. Find 300 00:16:33,720 --> 00:16:37,080 Speaker 1: things that you enjoy because chronic stress actually accelerates your 301 00:16:37,200 --> 00:16:41,200 Speaker 1: estrogen decline. Maybe that's why my estrogen declined so quickly 302 00:16:41,240 --> 00:16:43,600 Speaker 1: in my life. I don't know. I'm busy all the time, 303 00:16:43,680 --> 00:16:45,800 Speaker 1: but I actually really enjoy my life. That's where I'm 304 00:16:45,840 --> 00:16:48,520 Speaker 1: saying that in jest. One big thing for women, and 305 00:16:48,520 --> 00:16:50,160 Speaker 1: I'm not going to go deep into this right now 306 00:16:50,200 --> 00:16:52,160 Speaker 1: because i think we're going to do a follow up 307 00:16:52,200 --> 00:16:56,120 Speaker 1: episode to talk about this, but strength training and resistance 308 00:16:56,160 --> 00:17:01,680 Speaker 1: exercise absolutely crucial in perimenopausal and menopose women. You hear 309 00:17:01,760 --> 00:17:05,200 Speaker 1: all these stories, see all of these reels online about 310 00:17:05,200 --> 00:17:08,199 Speaker 1: women wearing those weighted bests and just walking around. I 311 00:17:08,240 --> 00:17:10,280 Speaker 1: mean that itself is a new badge of honor for 312 00:17:10,480 --> 00:17:13,760 Speaker 1: women in their perimenopausal age. I admit I do not 313 00:17:13,960 --> 00:17:16,919 Speaker 1: have a weighted best, but I may I may be 314 00:17:17,040 --> 00:17:19,960 Speaker 1: purchasing this soon because I've been reading a lot about them. 315 00:17:20,240 --> 00:17:24,479 Speaker 1: The reality is, building muscle also protects your bones. It 316 00:17:24,600 --> 00:17:28,080 Speaker 1: helps regulate your insulin, and it's crucial for your brain 317 00:17:28,119 --> 00:17:30,879 Speaker 1: health too. And you wouldn't expect that, but yeah, the 318 00:17:30,880 --> 00:17:33,679 Speaker 1: more muscle you have, the more oxygenation you have, the 319 00:17:33,720 --> 00:17:37,080 Speaker 1: stronger your bones are. It all comes together. It's like 320 00:17:37,080 --> 00:17:39,040 Speaker 1: the circle of life and the lion king it all. 321 00:17:39,240 --> 00:17:41,640 Speaker 1: It's not just one thing. You don't just work out 322 00:17:41,720 --> 00:17:44,600 Speaker 1: for your muscles. You work out for your brain, for 323 00:17:44,680 --> 00:17:47,159 Speaker 1: your heart health, for your family, because you're going to 324 00:17:47,160 --> 00:17:50,280 Speaker 1: be around longer for your family. So here's the unmasked truth. HRT, 325 00:17:50,400 --> 00:17:53,160 Speaker 1: when used correctly and started at the right time, can 326 00:17:53,280 --> 00:17:57,280 Speaker 1: protect women, not necessarily harm them. It can significantly improve 327 00:17:57,280 --> 00:18:00,960 Speaker 1: their quality of life and even prolong their life disease free. 328 00:18:01,200 --> 00:18:04,760 Speaker 1: It's important though it is started early. If you start 329 00:18:04,760 --> 00:18:08,040 Speaker 1: it after you've gone through menopause, the risk benefit may 330 00:18:08,080 --> 00:18:11,320 Speaker 1: not be nearly as there the earlier start, probably the 331 00:18:11,320 --> 00:18:13,400 Speaker 1: more benefit you will get. So it's time to strip 332 00:18:13,480 --> 00:18:16,080 Speaker 1: away that fear, the outdated headlines, and the one size 333 00:18:16,119 --> 00:18:19,240 Speaker 1: fits all thinking, because when it comes to hormonal therapy 334 00:18:19,320 --> 00:18:22,560 Speaker 1: and women's health, it's time we start making decisions based 335 00:18:22,600 --> 00:18:25,479 Speaker 1: on fact and not fear. Thanks for listening to Wellness 336 00:18:25,520 --> 00:18:29,280 Speaker 1: on Mass on America's number one podcast network, iHeart. Follow 337 00:18:29,320 --> 00:18:32,160 Speaker 1: Wellness on MASS with doctor Nicole Saffire and start listening 338 00:18:32,200 --> 00:18:35,560 Speaker 1: on the free iHeartRadio app or wherever you get your podcasts, 339 00:18:35,600 --> 00:18:37,040 Speaker 1: and we will catch you next time.