Understanding Your Hormones Video Series

Part One: The misconception behind Hormone Replacement Therapy, the NIH study and what you can do to combat the early symptoms of menopause

With Dr. Anita Sadaty and Hayley Foster

I have the honor tonight of introducing you to Dr Anita Sadaty. She’s a board-certified OBGYN and an integrative Medicine practitioner and she provides individualized personalized Medical Care focusing on discovering the underlying factors that cause illness and the symptoms that many of us on this call have probably experienced are experiencing or will experience in the future so and full disclosure the information you’re going to hear tonight is for educational purposes only and it is not individual medical advice for anybody on this call. If you do want to work with Dr. Sadaty we could give you her information at the end and tell you how to do that and again this is not a sales pitch to work with Dr Sadaty this actually came up as something that I have been asked numerous times by numerous people a lot of who are on this call tonight like “I hear you’re taking taking hormones like aren’t you worried about this are you worried about that” and so I felt like why not put this out there as a conversation that other people could take part in and so here we are so anything you want to add before we jump in Dr Sadaty?

I think that it’s such a hot topic it certainly hits a lot of buttons for women at all ages it’s probably one of the most common things that I’m seeing in my office right now because there is more information out there there’s more dialogue there’s more conversation and so women are really sort of asking the question is hormone replacement appropriate for me what does it do for me what are the upsides what are the downsides when should I start like all of these questions are exactly what’s coming into my office so I think it’ll be a good discussion I think the place where we could start off is talking about the fear behind hormone replacement therapy and maybe just give us a quick summary of how do you alleviate some of that fear for people that are coming to you and saying I’m scared of hormones okay that and that’s and that is a big question.

I think that we have to put this in the context of the history of of why we are in a situation where so many women are fearful of hormone replacement therapy and I was a young you know practicing OBGYN when this started so in 2002 when the Women’s Health Initiative which was the largest double blind Placebo controlled trial comparing hormone replacement therapy to Placebo in an effort to see whether or not this could reduce cardiovascular disease events um it was over 1 billion dollar study what ended up happening was a small subsection of the investigators on this on this study noted a signal that they thought was concerning for breast cancer in the women who were taking hormone replacement therapy. They then proceeded to write an article that was published in the Journal of American Medical Association that essentially claimed hormone replacement therapy increases the risk for breast cancer and that women should not consider this as an option for their health.

This was plastered all over the media every magazine every news agency every newspaper every physician every woman was struck with fear. Women were pulled off of hormone replacement therapy right away and it was denied to a lot of women who were in really indeed suffering from severe menopausal illness and symptoms so fast forward this has been the narrative essentially for the last 20 years when you look at that study more carefully what you end up seeing is that first of all the risk of breast cancer in the hormone replacement therapy arm was not statistically significant. That alone shuts down any statement that could possibly have been made to say that hormone replacement therapy increases breast cancer risk.

Now the reason that this it was so shocking at the time was because there were so many studies the preponderance of the evidence in the scientific literature pointed to a null effect most likely on breast cancer risk as a matter of fact between 1975 and the year 2000, 83% of studies showed no increased risk of breast cancer. So that study was out of line with everything else that we had learned about. Let’s also look at so number one not statistically significant right then and there that study should not have been published as and many of the investigators did not agree with the conclusions of that study but they were not given an opportunity to even voice their concerns or the reasons why this shouldn’t have been published and that the study should not have been stopped prematurely.

The second issue is that the women in the study did not represent the typical woman who’s going into menopause the average age of those women was 63 so those women were well 10 years out of menopause on average these were and and and on top of that these were not healthy women. 70% of the women were overweight 50% of them were smokers 30% had high blood pressure – so these were not healthy newly menopausal women. This did not represent what most women looked like when they were looking to potentially use hormone replacement therapy as either a symptom relief strategy or an anti-aging health benefit strategy. So those are two huge issues with the study right then and there and and really it one of the things that we can pull from it is that there is in fact a critical window of opportunity of when you can start using hormone replacement therapy to reap the benefits of hormone replacement such as reducing heart attack and stroke risk reducing osteoporosis hip fracture risk reducing dementia risk reducing colon cancer. There are a lot of of overall health benefits if you start this within 10 years of becoming menopausal.

For a more comprehensive understanding, I recommend reading Estrogen Matters by Dr. Avrum Bluming. This book is outstanding; as an oncologist, Dr. Bluming meticulously dissects the Women’s Health Initiative study data, presenting it in a clear and comprehensible manner. He demonstrates that the conclusions drawn from the study were fundamentally flawed.

Additionally, there have been two notable articles in the past year or so from The Wall Street Journal and The New York Times that examine the Women’s Health Initiative study and deconstruct it similarly. These articles provide a great breakdown of the study and are readily available online.

Now, let’s discuss what happens to women’s bodies as they transition through their 30s, 40s, and 50s, particularly concerning hormonal changes. Menopause is a hot topic, but many people are either not yet experiencing its effects or are just beginning to.

In your 30s, hormonal production is at its peak, and issues in this decade are not typically related to hormonal deficiency. Instead, imbalances may occur. Women in their 30s experiencing hormonal imbalance might have symptoms such as PMS, breast tenderness, bloating, moodiness, anxiety, fatigue, headaches, heavy periods, and bleeding between periods. These symptoms reflect hormonal dysregulation rather than a production issue.

Lifestyle factors such as stress, sleep, nutrition, exercise, and gut health play significant roles in how hormones are processed and eliminated. Imbalances in any of these areas can lead to symptoms of hormonal imbalance.

In your 40s, you may experience both hormonal deficiency and imbalance. Estrogen levels begin to decline, and progesterone, which tends to decrease as egg quality and ovulation change, may become less balanced with estrogen. Symptoms can vary widely, from estrogen dominance – causing heavy periods, bleeding, cramping, and PMS – to estrogen deficiency, which may lead to hot flashes, night sweats, vaginal dryness, painful intercourse, reduced libido, and difficulty achieving orgasm.

Entering your 50s, the decline in both estrogen and progesterone becomes more pronounced. Symptoms in this decade often include more hot flashes, night sweats, anxiety, palpitations, vaginal dryness, painful intercourse, and depression. Many women in their 40s and 50s who suffer from depression find it is often related to hormonal imbalances, including deficiencies in estrogen, testosterone, and progesterone. Low progesterone, in particular, is linked to anxiety and panic. In my previous practice, I frequently saw women in their 40s and early 50s seeking emergency care for what they thought were heart attacks, only to find their symptoms were actually due to progesterone deficiency.

It’s also worth noting that many doctors, particularly those focused on traditional gynecology, may not always diagnose these hormonal symptoms accurately. Women may go for years on birth control without understanding its impact on their hormones. Birth control pills are often used as a catch-all solution for various hormonal issues, but they can mask underlying problems and shut down the body’s natural endocrine system. This approach can prevent the identification and treatment of the root causes of hormonal imbalances.

For women in their 50s and beyond, birth control pills are sometimes prescribed to manage symptoms like hot flashes or night sweats. However, this is a high dose of foreign hormones compared to bioidentical hormone replacement therapy, which uses hormones your body naturally produces. There’s a misconception that birth control pills are a safer option, but this is not supported by evidence. The fear surrounding hormone replacement therapy has led to an over reliance on birth control pills, which is not necessarily a better choice.

The main concerns with long-term use of birth control pills include masking symptoms rather than addressing underlying issues and potentially causing side effects such as low libido and vaginal dryness, which may not always be reversible even after stopping the pill.

Fortunately, for most women, any symptoms related to birth control pills should resolve within three to six months after discontinuation. However, for some, the elevated levels of sex hormone-binding globulin can remain high, making it challenging to return to normal levels.

There is often confusion between synthetic hormones and bioidentical hormones. Bioidentical hormones are designed to be chemically identical to the hormones naturally produced by your body. They are not derived from yams or other plants, and while they might be compounded by specialty pharmacies, this is not a requirement for bioidentical hormones.

Bioidentical hormones include estradiol, estriol, and estrone for estrogen; progesterone for progesterone (not synthetic forms like medroxyprogesterone or norethindrone); and testosterone in its natural form. In contrast, the Women’s Health Initiative study used hormones such as Premarin, which is derived from pregnant mares’ urine, and Provera, known to cause cancer in animals. Despite this, the estrogen-only arm of the study showed a decreased risk of breast cancer, illustrating that even non-bioidentical hormones had some positive outcomes.

Bioidentical hormones can be administered in various forms, including oral pills, creams, patches, vaginal inserts, capsules, and pellets that are injected under the skin. Many of these can be obtained from regular retail pharmacies and do not necessarily need to be compounded. The key aspect of bioidentical hormones is that they have the same chemical structure as those naturally produced by the ovaries.

Regarding cost and insurance coverage, compounded hormones are typically more expensive because they are made to order, which involves more time and effort. Insurance coverage for compounded hormones varies and is often less comprehensive compared to retail pharmacy options. If your insurance covers bioidentical hormones from a regular pharmacy, it is usually more economical. However, if you require a specific form or dosage not available at a retail pharmacy, compounding might be necessary.

Compounded hormones are necessary when the available forms or dosages at a regular pharmacy do not meet your needs. For instance, if you need a non-standard dose of progesterone or testosterone, compounding can provide a tailored solution.

Now, regarding the consequences of not using hormone replacement therapy, it’s important to recognize that hormone therapy is not solely about managing symptoms but also about addressing broader health concerns. Women often worry about breast cancer, but it’s essential to consider other health aspects as well, such as brain function, heart function, kidney function, and skin health.

The discussion should include the potential risks of not using hormone replacement therapy, just as it does for taking it. Women who cannot or should not take hormone therapy typically include those with active estrogen-sensitive cancers, such as breast or uterine cancer. In an ideal medical environment, women would be able to make informed decisions based on their research and health needs, even if this might not always align with conventional medical recommendations.

Regarding blood clots, women who have experienced them are typically on medication to prevent further clotting. Therefore, HRT is unlikely to override their medication’s effects. Additionally, estrogen administered through the skin does not increase blood clotting factors, so it is not generally considered a contraindication.

The benefits of taking hormone replacement therapy include a longer lifespan and a significant reduction in cardiovascular events. On average, women on HRT live about three years longer and have a 30 to 50% decreased risk of heart attacks or other cardiovascular issues. To put this into perspective, approximately 40,000 women die from breast cancer annually, whereas about 250,000 die from heart disease. Therefore, heart disease is the more prevalent risk.

It is also worth noting that women over the age of 65 with a diagnosis of breast cancer are more likely to die from heart disease rather than breast cancer. This highlights that women’s health involves various systems beyond just reproductive organs.

Additionally, HRT can positively impact cognitive health. Using hormone replacement therapy for at least 10 years can reduce the risk of developing dementia by 30%. It is important to start HRT before being 10 years post-menopause to maximize these cognitive benefits. Initiating HRT too late may not only be ineffective but could potentially increase dementia risk.

HRT is also beneficial for bone health, significantly reducing the risk of osteoporosis and hip fractures. While alternative treatments for osteoporosis exist, they often come with risks, such as increased cancer risk or unstable bone formation, making HRT a preferred option for many.

Other benefits of HRT include decreased risk of colon cancer, improved urogenital symptoms (such as reduced incontinence), and enhanced sexual health, including more enjoyable and less painful sex. HRT can also help reduce skin aging by maintaining collagen and elastin levels, contributing to healthier skin overall.

Hormone replacement therapy (HRT) offers several benefits, including a decreased risk of autoimmune diseases. For example, women with multiple sclerosis (MS) may experience fewer symptoms and slower progression when on HRT. Additionally, many women going through menopause experience increased joint aches and pains, which can sometimes be misdiagnosed as fibromyalgia. This discomfort often results from declining estrogen and progesterone levels.

Beyond alleviating symptoms such as hot flashes and night sweats, HRT can have broader health benefits. As women age, particularly in their 30s through 70s and beyond, making certain lifestyle changes can help mitigate menopausal symptoms.

For instance, eliminating or reducing alcohol consumption can be particularly beneficial. When I stopped consuming wine over a year and a half ago, I noticed a significant reduction in night sweats and heart palpitations that had previously occurred even with minimal alcohol intake. The alcohol, despite being “clean,” was still triggering these symptoms.

Diet and exercise also play crucial roles in managing menopausal symptoms. Many women find that their bodies crave wine, which can be detrimental to health. Wine is high in sugar and acts as a liver toxin. During the night, the liver is supposed to detoxify and process hormones and medications. Introducing toxins and sugar disrupts this process, leading to inflammation and adrenaline responses that can cause hot flashes and night sweats.

To manage blood sugar levels and minimize these symptoms, it is helpful to avoid alcohol and caffeine, reduce snacking throughout the day, and focus on consuming balanced meals rich in protein and vegetables. Ideally, aim for three well-balanced meals a day with about 30 grams of protein per meal and limit processed foods. When blood sugar levels are stable, hot flashes and night sweats tend to decrease.

Interestingly, wearing a continuous glucose monitor can provide real-time data on blood sugar fluctuations. It has been observed that while alcohol initially lowers blood sugar, it often leads to a spike later in the night. This spike can contribute to symptoms such as heart palpitations and disrupted sleep.

In summary, balancing blood sugar through dietary adjustments and eliminating certain triggers like alcohol can significantly alleviate menopausal symptoms, sometimes even without the need for hormone replacement therapy.

Using a continuous glucose monitor (CGM) was an eye-opening experience for me. I observed significant differences in my blood sugar levels depending on whether I ate three balanced meals a day or practiced time-restricted eating. Managing blood sugar effectively can profoundly impact symptoms of menopause, and this could be a topic for further discussion.

In my practice, I often start by guiding patients towards an anti-inflammatory diet and focusing on sugar balance. Many symptoms, such as anxiety and insomnia, are closely related to caffeine intake. Even a small amount of caffeine can disrupt sleep and exacerbate anxiety because it takes about 24 hours to metabolize caffeine fully. Once patients eliminate caffeine, they often experience improvements in anxiety and sleep disturbances.

Adjusting dietary habits can lead to significant changes in overall well-being. Reducing or eliminating caffeine, alcohol, and processed snacks, while focusing on stable blood sugar through balanced meals with ample protein, can alleviate fatigue, mood swings, headaches, and afternoon energy drops.

While I haven’t completely given up coffee, I don’t experience sleep issues or headaches from it, so it’s manageable for me. However, if someone is dealing with sleep disturbances or hot flashes, they might need to consider reducing or eliminating coffee.

One practical approach I recommend to patients is to remove caffeine and alcohol from their diets for two to three weeks to assess any improvements in symptoms. If their symptoms persist, these substances might be contributing factors.

Regarding education for medical professionals, there is ongoing concern about how well new generations of doctors are being trained on female reproduction, hormones, and menopause. With projections suggesting that a billion women will be in menopause by 2025, it is crucial for medical schools to update their curricula. Unfortunately, I don’t have direct insights into current medical school training, as I no longer work in a hospital setting and don’t interact with medical students or residents regularly.

However, my experiences suggest that some younger gynecologists may still hold outdated views. For example, a patient of mine, who had been on hormone replacement therapy for years and felt well, was advised by a younger gynecologist to discontinue it due to concerns about breast cancer risk. Despite her preference to continue, the doctor reduced her dosage, leading to significant declines in her health, including severe body pains, poor sleep, brain fog, and fatigue. This case highlights a potential gap in understanding and suggests that there is still work needed to ensure that emerging practitioners are well-versed in the complexities of hormone replacement therapy.

The approach to medical education and treatment continues to evolve, but there are still challenges. From my experience, medical students I encountered seven years ago were heavily influenced by pharmaceutical-driven practices. They often leaned towards prescribing medications for various symptoms, such as antidepressants, anxiolytics, and pain medications, rather than exploring hormonal or lifestyle interventions. This is partly due to the influence of pharmaceutical funding on medical schools. While there is growing demand from patients for more comprehensive approaches, change in medical education may be gradual.

Regarding hormone replacement therapy (HRT), initial testing is crucial to determine its appropriateness. For most patients, regardless of age – be it their 30s, 40s, 50s, or 60s – the gold standard for evaluating hormone levels is serum testing, which involves blood tests. The timing of these tests is important:

❯ For women still having periods: To assess peak hormone levels, it is best to test about one week before the expected start of their period. This will provide insight into their peak estrogen and progesterone levels.

❯ For women in their 40s: Testing should also include pituitary hormones like FSH and LH, as rising levels may indicate a decline in ovarian sensitivity to hormonal signals from the brain.

❯ For menopausal women: If a woman has not had a period for a year or more (typically over age 45), her estrogen and progesterone levels will naturally be low, making it almost redundant to test these hormones. Instead, it is beneficial to test testosterone and DHEA (an adrenal hormone) which supports women during menopause. DHEA is often referred to as the “anti-aging” hormone because it converts into estrogen and testosterone, contributing to overall hormonal balance and longevity.

Testing should also be used to monitor hormone levels after starting HRT to ensure they are adequate for providing bone, heart, and brain protection. Hormone levels can vary from day to day, especially for women who are still menstruating, so it’s essential to consider this variability in testing and treatment decisions.

In summary, while traditional medical education has leaned towards pharmaceutical interventions, there is a growing recognition of the importance of hormone management and lifestyle changes. Testing plays a key role in personalizing and optimizing hormone replacement therapy to achieve the best outcomes for patients.

Here’s a brief overview of the discussion:

1. Hormone Testing Options
• Dutch Test: A dried urine test that analyzes cortisol and hormone metabolites. It helps track how hormones are broken down and if there are any potentially toxic byproducts.
• Serum Testing: Traditional blood tests to measure hormone levels. Testing timing is crucial, especially if still menstruating. For menopause, hormone levels are typically low, but testing testosterone and DHEA can be informative.
2. Testing Frequency:
• Dutch Test: Frequency depends on individual results. For example, if adrenal or estrogen breakdown issues are identified, retesting every 3-6 months may be necessary to gauge the effectiveness of interventions.
3. Alternative Approaches
• DHEA Supplements: Can help balance hormones indirectly by supporting adrenal function.
• Adrenal Balancing: Addresses hormonal symptoms by correcting adrenal hormone imbalances, which can be a root cause of various symptoms.
4. Advice and Advocacy
• Self-Advocacy: Women should have open conversations with their healthcare providers about symptoms and treatment options. If the current provider isn’t responsive or knowledgeable about hormonal treatment, seeking a specialist might be necessary.
• Educational Resources: Engaging with reliable sources of information and continuing to educate oneself about hormonal health can be beneficial.
5. Closing Thoughts
• The importance of finding a healthcare provider who is a partner in managing hormonal health was emphasized. Patients should advocate for their needs and not settle for less-than-optimal care.

Please Note: This transcript was computer-generated and may contain inaccurate translations. For accuracy, watch the video in its entirety.

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Ready for the legal disclaimer? Information offered here is for educational purposes only and does not constitute medical advice. As with any health recommendations, please contact your doctor to be sure any changes you wish to consider are safe for you!