Hormones 101:

What You Need To Know About Your Hormones and Hormone Replacement Therapy

With Dr. Anita Sadaty and Hayley Foster

Again, thank you all for coming. I am Haley Foster again. I’m 51 and I have three teenagers at home. I’m in the perimenopause stage of my life. I was saying that one of the reasons why I started working with Dr.Sadaty 4 years ago was that I decided that I don’t want to go through menopause.

So, I jumped into hormone replacement pretty early pre symptoms. And, we’re gonna get to a lot of the discussion tonight on when is the right time, what should I be doing, how old should I be, and I’m happy to say that we have people on this call tonight that are in there, twenties, thirties, forties, fifties, and sixties and maybe even above. So we have a really nice range of people here tonight and We’re going to give you as much information as we can to help you on this journey because it is a journey.

So I have the honor tonight of introducing you to Dr. Anita Sadaty. She’s a board certified OBGYN and an integrative medicine practitioner. 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 or will be experiencing in the future. So and full disclosure, the information you’re gonna 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 menopause I hear you’re taking hormones like aren’t you worried about this 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, Doctor?

No, 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, and that’s a big question. I think that we have to put this in the context of the history 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. It was over a 1 million 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 tournament 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 Okay. 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 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 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 1,975 and the year 2,083% of studies showed no increased risk of breast cancer. So that study was not 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 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 public 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 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 really 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 calling cancer. There are a lot of overall health benefits if you start this. Within 10 years of becoming menopausal.

The women who had issues such as increased blood clots or heart attack or stroke. We’re more than 20 years out from menopause. In that study. So when you remove those women from the study, there was no increased risk of cardiovascular disease. As a matter of fact, it showed a protective effect. So it’s really all in analyzing the data very carefully and looking to see where those signals were present.

So it’s a mouthful and I think it’s kind of a lot to start the conversation from there. But what I would urge most women to do if they really want to stand this more clearly is to consider reading a book called Estrogen Matters by Dr. Avram Blooming. This book is phenomenal. He’s an oncologist and he lays out all of the data as it was presented over the years. He, he really disects the Women’s Health Initiative study data in a way that makes it very understandable and also makes it very clear that the conclusions were completely informed.

Right. And I want to also just add on to that. There have been two articles in the last year. A year and a half from the Wall Street Journal and the New York Times that do talk about the Women’s Health Initiative study. And really deconstructing it and laying out a lot of what you just summarized so eloquently. And so if anybody wants to read those articles, they are out there. You can just, you know, use the Google machine.

Okay. They really do a great job of breaking it down. So as I said earlier, and I think this it’s a really great jumping off point and I think it gives people sort of like that. Alright, what is it that I should be focusing on? So what I would love to do really is kind of go backwards a little bit and talk about like what is happening with women as they hit their thirties and forties and fifties.

As far as hormones go just to give us a little bit of background. You know, people aren’t really diving in. Your menopause is such a hot topic right now and such a buzzword, but a lot of people just are, you know, like I’m not there yet. I’m not there yet and don’t really want to know what’s coming. Or they’re just starting to feel the effects and not necessarily I mean a lot of people are on this call right now. So people are doing some research and diving in a little bit but tell us what’s happening in our bodies as we hit those key ages of our thirties, our forties and our fifties.

So that’s a good question. In the thirties. That decade to the twenties and thirties are when you see sort of the largest production of hormones. And the issues that occur in in your twenties and thirties isn’t related to let’s say deficiency of hormonal production. That’s what starts to happen in your forties and your fifties and beyond. But what you can start to see is imbalances and hormones. So women in their thirties if they have hormonal imbalance are going to have very sort of prototypical symptoms that we think about like PMS symptoms, breast tenderness, bloating, moodiness, anxiety, fatigue, headache, heavy periods, prolonged periods bleeding between periods like these are all symptoms of hormonal imbalance or disregulation.

That particular decade let’s say in your thirties that’s when a lot of lifestyle influences are at play. So whether you’re having a regular periods or regular periods and symptoms that is an imbalance in your hormones, but that doesn’t mean that your ovary doesn’t know how to produce hormones. That has more to do with how your body is responding to hormones, how your body is processing hormones and how your body is eliminating and detoxifying hormones. So if you have issues in any three of those steps. There could be production issues, there could be metabolism issues, there could be elimination issues, then you’re going to have symptoms. Hormonal imbalance. So that’s where lifestyle factors are really critical. Stress, sleep, nutrition, exercise, you know, all other other inflammatory disorders that can happen at that time. Those, and certainly gut disorders are in balance. So all of that. Heavily influences how your hormones are going to express.

In your forties you have kind of both issues you have to deficiency issues but you also have imbalance issues. So your hormones start to decline in your forties but it may be that your estrogen levels are still out of balance to your progesterone. So progesterone tends to be the hormone that we start to miss a little bit more that because the eggs are getting a little older, the quality of your ovulation changes and your progesterone production changes.

So many symptoms. I mean, it could be all over the board. You can certainly have estrogen deficiency, but most of the time we see what we call estrogen dominant symptoms where there’s not enough progesterone to balance the estrogen that you’re producing. And therefore you can get symptoms of heavy periods, faucet like bleeding when you get a period. Lots of cramping, prolonged bleeding, PMS headaches like all those other symptoms.

However, you can also be in the deficient side where you’re now starting to get hot flashes, night sweats before your period or you’re starting to experience some vaginal dryness or painful intercourse because the vagina is very sensitive to declines in estrogen. You can start finding like loss of libido or more difficulty with orgasm. So those are those are symptoms that happen potentially late thirties or early forties.

Once you start moving into the fifties, That’s when the decline of both hormones is pretty significant for some. I mean, I still have patients that are you know, 57, 58 and having regular periods to their chagrin. But I tell them, listen, you’re gonna, you’re gonna miss your hormones when they go, so enjoy.

But they are experiencing typically more deficiency syndromes. More hot flashes. More nights sweats, more anxiety, palpitations. You wake up with palpitations, heart palpitations. Vaginal dryness, painful intercourse. Depression is big. So a lot of women in their forties and fifties who are suffering from depression, it really is often related to hormonal imbalance and estrogen deficiency or testosterone deficiency. All of those and progesterone as well, low progesterone is highly associated with anxiety. And panic so I used to in my older practice when I was younger I remember all of these women in their forties and early fifties going to the emergency room thinking they had a heart attack.

But really what they were having was progesterone. Deficiency mediated palpitations and anxiety and panic. So, you know, they would get the 1 million dollar workup for EKGs and echocardiogram and enzymes to cardiac enzymes sold for heart attack. And really what they needed was progesterone. So that’s sort of what’s happening in each of those decades.

And that’s, you know. I don’t want to start talking about how So many doctors are just not aware of diagnosing those symptoms and you know we’re fortunate to have somebody like you who is on the functional medicine side on the OB side as well.

Who the gynecological side who has that information and is able to you know, diagnose in a different way than a lot of traditional OBGYN practitioners who you know a lot of times and I will just relate this to myself is that You know, I was on birth control for a million years and then I was on an IUD for, you know, another 10 years after I had children. And at no point during any of that or was my and I loved my gynecologist but at no point was she talking to me about what any of this could be doing to my hormones. And so, you know, some people that may be on this call in their twenties, thirties, even women I know are in their fifties and sixties are put back on birth control. Can you touch on that a little bit? Cause I think that there’s…

Yeah. I would love to talk about that. So, and this is from somebody who was a huge prescriber, oral contraceptives for the majority of my career. I really don’t think that there’s enough discussion about what the downsides of oral contraception is. Unfortunately, you know, The doctors that are supposed to be the experts in hormone. Like gynecology or endocrinologist. They’re the first ones to just rush to put you on a birth control pill, regardless of what your problem is. It doesn’t matter not getting your period getting it too often too heavy too light too crampy to you know PMS headache whatever It’s used as a panacea to deal with any hormonal issue, endometriosis, fibroids, ovarian cysts like ruptures, it’s like anything.

You speak about, it’s a birth control pill. And then what happens is that It’s certainly very convenient, but you’re basically ignoring what’s happening under the hood. Because the birth control pill is shutting down your own endocrine. Communication system. And it’s and your hormone like I like to call the period the 5th vital sign. So if your period is not normal, and you’re suffering or there are issues around your cycle. That is telling you there’s something not right with your health. So to then just slap on a birth control pill to shut off the symptom. It’s like putting tape over the check engine light when it shows up. It’s like, let’s just cover that up and I’m not going to look at that. Okay, that’s not helpful. So here we are, women going years and years and years and years on a pill.

To then stop it because they want to try to get pregnant or stop it in their fifties to find out they have all kinds of issues going on that were essentially ignored there’s no search for why it is that you’re experiencing these hormonal imbalance issues. So that’s one of the biggest reasons that I really have concerns about using birth control pills because they are there forever. Women don’t use them for a few months. They’re using them for decades. And women are using them as hormone replacement. So in your fifties, if you start experiencing hot flashes or night sweats, but you’re still having a period. You’re put on a birth control pill because there’s this false sense that somehow that’s safer.

Then being on low doses of bio-agentrical hormone placement, birth control pills are high doses of foreign hormones. So how that is considered better than putting you on hormones that your body makes, which is what you would use if you’re doing hormone replacement therapy. At low doses to fix the imbalance is beyond me. Like why that’s a safe option.

In your fifties and even as you said even into your sixties. Makes no sense to me.

It’s it’s because the narrative of how horrible hormone placement therapy is has really clouded the judgment of of physicians, like they’re just completely afraid of it, but they have no problem putting on somebody on massive doses of hormones like you find in a birth control pill. And not just a narrative, it’s a false narrative that. We’re learning, right? It’s not even a real narrative.

Right. Right. It is awesome. It is false.

And so, so there’s two parts to it. First, it’s the covering up your symptom, not, you know, and just ignoring. But the second part is you’re not looking for why there’s the problem. And that problem will affect your health eventually.

And it will eventually pop up somewhere else.

So. It’s gonna pop up. You know, you just so so those are my biggest concerns.

There also is a situation there are some women who when they go on birth control pills because of the effect of the birth control pills on the liver in terms of increasing. Sex hormone binding globulin which does sort of sequester all of your hormones including testosterone.

A lot of women have low libido. And vaginal dryness on a birth control pill and painful intercourse and in some cases it’s not reversible. Even when you stop the pill. And that’s certainly not something that people are saying. Fortunately for most women it is reversible if you stop the pill within 3 to 6 months those symptoms should resolve. But in some it doesn’t. The sex hormone binding globulin elevation will stay elevated. And it’s tricky to try to get that back down. So…

Can you talk briefly? I think there’s a lot of confusion between a synthetic hormone and a bio-identical hormone.

Yes, so, a lot of people think that when you’re talking about a bioidentical hormone replacement that you’re talking about, something that comes from a YAM. Or some naturally designed plant source. It’s not something you can get from a regular pharmacy. It has to be compounded. It has been made by specialty formulas. None of that has anything to do with bio-identical. Bio identical basically just means that the hormone that you’re taking is the exact same chemical structure as what your ovaries formerly made. So if it’s. Bye-identical estrogen, it would be estradiol. Or estriol or estrone. Those are the three estrogens your body makes. If it’s progesterone, it’s progesterone.

It’s not hydroxy progesterone, it’s not norethan drone, it’s not any of these weird words. It’s progesterone, same structure. And testosterone is again testosterone. It’s not a Patentable, mutated form of a hormone. That was also another interesting aspect of the women’s health initiative is that the hormones that were used were not bio-identical. They were premarin, which is extracted from pregnant horses. You’re in. So print, in pregnant, mares urine. And Provera. Which was known to cause cancer in animals. So that wasn’t the best choice.

But even, even though, you know, even though that’s what they used, the, The, estrogen only arm in the women’s health initiative showed actually a decrease risk of breast cancer. So, so even though the primerin is bio-identical to a horse and not a woman, it was still pretty good. So. So that’s all the bioidentical means. You can get those, in many forms. You can get them as oral pills. You can get them as creams, you can get them as patches, you can get them as vaginal inserts, capsules, there can be pellets that are injected under the skin. You can get many of these from your regular retail pharmacy. Does not have to be compounded. All it means is that the structure is the same as what your ovary produced. That’s a biogenical means.

Thank you for that. And And then in terms of Is there a price difference or is it insurance dependent on bio-identical? Hormones from a compound pharmacy. Is there a reason to go to a compound pharmacy versus a regular pharmacy?

There are there are good reasons to use compounding. So number one. If the form or the dosing that’s available at a retail pharmacy doesn’t work for you. And you need to get a dose that is very personalized to you because you’ve not been able to, you’re not finding the balance with what’s available. Then you would want a compound. If a form of the hormone is not available that you need, for example, Most progesterone is used as an oral pill. Project micronized progesterone. But it’s available in two doses. 100 milligrams and 200 milligrams. Both of which in my opinion are a little high to start with. So if you needed 50 milligrams, then you need to compound it. Or if you need a progesterone cream, then you need to compound it. Testosterone, there is no option at a regular pharmacy for women.

So that has to be compounded. For sure compounding is more expensive. If you have insurance that will cover biotechnical hormone replacement from your pharmacy, it’s usually going to be more. Economical compounding means that they are literally making this stuff from scratch for you. So it’s, you know, more time consuming, there’s more effort, the ingredients have to be purchased for you. It has been made in a special way. So there’s cost to that. Whether or not your insurance covers it, I think is very insurance dependent. I mean, as you know, insurance wants to cover nothing. So. They would probably say no. But that’s not. You know, that’s neither here nor there if you need it in a special way, then you kind of have to bite the bullet. But for the most part, I would say. 80 to 85% of women can get away with what’s available at a regular pharmacy.

Okay, thank you. Something you touched on earlier and I wanna come back to it. Was the almost like consequences of not taking hormones if you are a woman and you and I had a conversation. About women fearing this one thing that can affect them which is breast cancer right women fear breast cancer and your comment was we’re not walking around as a giant boob. There’s a whole there’s all these other parts of our bodies we should be worried about not just our boobs, right? So there’s brain function, there’s heart function, there’s kidney function, there’s skin function, and so can you talk a little bit about what you see as the consequences of not? Taking hormones. As a supplement.

And that, you know, that should be how the discussion is couched, right? That there are risks to not taking hormone replacement therapy, just like there may be some risks to you in terms of taking it. And we can jump into that. So. Regarding women who cannot take hormone replacement therapy or should not take it. You know, in an ideal world. The medical community would allow a woman to make their own decision about it, but there’s a lot of paternalism in medicine and you’re told that you can or you can’t. Even if you’ve done the research and you’ve made the decision that this is the best health option for you. That may not be. Blessed by your by your physician. So, but the only reason that you really can’t go on hormone replacement therapy is if you had an active cancer that is estrogen motivated. Such as an a breast cancer or a uterine cancer if you’re actively dealing with that being treated for that.
Then most likely it’s not necessarily a great idea to go on something that could promote it. It doesn’t cause it, but it could promote it.

If you have unexplained vaginal bleeding like bleeding that’s not if you’re in the menopause it’s sort of never considered normal if you’re perimenopausal, if you’re having erratic strange unregulated bleeding you have to figure out what that’s from because otherwise it could be a uterine cancer until proven otherwise, which also can be stimulated by estrogen. So those are two big no-nos. The other one could be if you had some hormonally mediated blood clot. However, in my opinion, women who have had blood clots are typically on some sort of medication to prevent blood clots and therefore going on hormone placement therapy would not override your medication.

And if you take estrogen through the skin, it does not increase your rate of blood clot factors from forming. So I don’t even really think that is a contraindication. What are the downsides to not?

To not taking it. So on average Women live three years longer when they’re taking hormone replacement therapy. They have a up between a 30 to 50% decrease risk of any kind of heart attack event or cardiovascular event. And just to put that into perspective. 40,000 women a year may die from breast cancer but a quarter of a million women a year die from heart disease.

So if you’re talking about what is likely you just say that number again because it really is mind blowing.

So, 40,000 women a year. May die from breast cancer. 250,000 women a year die from heart disease. So if you’re gonna die from something, it’s most likely heart disease. And I read a statistic that Women over the age of 65 with the diagnosis of breast cancer. Most likely will die from heart disease, not breast cancer. So like we talked about, we’re not like one big walking boob. Like we have brains, we have bones, we have muscles, we have vaginas, we have hearts, we have all kinds of systems in our body. That require or do better function better with hormones. The other thing that we wanna look at is dementia. So if you were to use hormone replacement therapy for at least 10 years your rate of dementia would drop. So there’s a 30% decrease risk of developing dementia. If you were to use hormone replacement therapy for at least 10 years.

You also need to use it. Prior to being 10 years out. From menopause. If you started hormone replacement therapy, 10 years after menopause. You may not get the benefit or you may even increase the risk of dementia. So that’s why there’s this critical timeframe where getting on board with hormone replacement therapy. Reaps more benefits for patients. We also see decreased osteoporosis and hip fracture risk. Which in my opinion if a woman has osteoporosis Hormone replacement therapy is probably the best treatment for that.

A lot of the other alternative therapies for osteoporosis. Have a lot of risk, a lot of downside. The benefits are short-lived. Some don’t protect you from hip fracture. Some medications actually build very in unstable bone. Where you may be at risk for odd. Torsing fractures. A lot of these medications put you at increased risk for cancer. I mean, I don’t even, I, I don’t prescribe those medications. Like I just, I can’t. I’ll send somebody to an endocrinologist if they want a medication like that. But. So if we have hard disease production, brain protection, osteoporosis, hip fracturous protection, decreased risk of colon cancer, improved Eurogenital symptoms. So incontinence, how about that? Not peeing all over yourself. That’s kind of nice.

We have, More enjoyable sex, less painful sex, better orgasms. Skin so in general there is reduced skin aging because hormone replacement therapy can maintain collagen and elastin levels. You have a decrease risk of autoimmune disease. So there’s definitely evidence that women on hormone replacement therapy can who let’s say have MS have less symptomatology and less progression. So, certainly aches and pains like join aches and pains go skyrocketing for women in menopause and they don’t even know why it’s happening they don’t understand why all of a sudden they’re diagnosed with fibromyalgia. And it’s because they don’t have estrogen and pedestrian on board. So there are so many health benefits outside of not having hot flashes and night sweats. So… 

A couple of things that you and I talked about also that I want to address tonight are you mentioned this earlier are the lifestyle changes right so as we start entering our 30s, 40s, 50s, 60s, 70s, you know, all the way up, you know, from somebody who wants to, you know, make it into the hundreds. There’s lifestyle changes that you could be making in order to you know, reduce some of those symptoms that you may be experiencing from menopause. Do you want to touch on what some of those are? I mean, I could share, you know, some of the things that I’ve done for myself and I’m sure I’ll get a lot of booze on this one but And when you and I 1st met, I was very into my wine and selling wine and you know, I was a wine pusher, and over a year and a half ago stopped doing that and with that saw you know, the elimination really. No night sweats. No heart palpitations. I was having those symptoms on nights when I was drinking and not even drinking that much and I was drinking clean wine but I was still getting some of those symptoms. You know, I’ll let you jump in. I know, you know, food exercise, but I’ll let you talk a little bit more about what those lifestyle changes are.

Well, I think you hit the nail on the head of a big one. There is this sort of strange dichotomy between what your body wants. And how it reacts to when it gets what it wants. So for whatever reason in the forties and fifties women become they crave wine. And not even just alcohol but wine in particular and yet that is so, detrimental to health in general. And women get really angry that they sort of feel like they hit their late forties and fifties and like they cannot drink anything and it’s annoying, you know, because they really enjoy the wine but then they suffer. They wake up in the middle of the night sweating. Their sleep is completely disrupted. They get a headache like you basically become very intolerant to it.

So it’s a trigger. In particular, because wine is both high in sugar and it’s a liver toxin. And so your liver at night is trying to, it sort of has an opportunity in the middle of the night to start cleaning up the body. So it starts to eliminate toxins, deal with pollutants. Get rid of hormones that need to be processed out of the body, deal with some of the prescription medications that you’re taking like it’s it’s it’s the time for it to really clean up the body. You then add in at night a a toxin and a sugar. Those are two things now that the liver has to manage. So instead of doing cleanup for the day, it now has to dissemble this new toxin that you’re bringing in and it has to manage the sugar load. And both of those things create an inflammatory response and it also will create an adrenaline response. So in line with that, so any kind of blood sugar disregulation is going to cause hot flashes and night sweats.

So I know women that, you know, they say they eat well. They’re exercising, you know, they’re doing all the right things and they’re suffering from hot flashes and night sweats and anxiety and panic and all that other stuff.

So once you get rid of the alcohol, once you get rid of caffeine, Once you stop snacking throughout the day and grazing on like little Carby things. Eat a lot of protein and just stick with like three balanced meals a day. Aiming for about 30 grams of protein per meal. Lots of vegetables and less processed food, you will not have hot flashes and night sweats. They will go away because You’re when you are eating carby things throughout the day or snacking throughout the day. You’re actually trying to manage low blood sugar episodes. You just don’t know it. And then when you go to bed, here you are expecting to not eat for seven hours straight.

Not gonna happen. So your body is used to you snacking and eating all day long and then when you go to bed your blood sugar drops, you don’t have something to snack on so you get a hot flesh and a night sweat as a result of adrenaline coming up. And that’s what wakes you up. So. I can get rid of people’s hot flashes and I thoughts without hormone replacement. Balance your blood sugar, eat a lot more protein, not snack, stop the wine, stop the caffeine and you’re done. You don’t have any of that anymore.

Right. And, and I think that’s really hard for a lot of people, right? You know, it’s doing those things.

Yeah, what we went for.

You just listed four major lifestyle changes for people that’s not easy. And I will say one of the biggest things that helped me was wearing a continuous glucose monitor because you literally have the data and you can see the spike. Like in the moment like literally in the moment you can see it and The interesting thing is, and this is where the anomaly was that when you drink alcohol, whether it’s wine or tequila, I saw the question of tequila in the comments.

Just to keel account. You know, when you’re drinking at night, your blood sugar will actually decrease from the alcohol.

Right? As you’re drinking it, you’ll see the dip in your blood sugar. But what happens afterwards is this spike in the middle of the night. And you know, it’s not just the, it’s not just your blood sugar spiking, you know, you get the heart palpitations and all that stuff too.

But I will say a CGM was really just such an eye opening experience for me in terms of all of those things on days where I was just eating three meals a day. I wasn’t, you know, I wasn’t C or two meals a day because I was doing time restricted eating.

Okay.

I would see very different results on my CGM. And so I mean, that could be like a whole another conversation.

Okay.

About. You know, blood sugar management and how even just getting a hold of your blood sugar and managing that can help you with many of the symptoms of menopause as well.

Yeah, I mean, you know, that’s essentially the 1st thing that I do with most of my functional medicine patients is I try to get them moving it towards an anti inflammatory diet but more importantly is to eat in a sugar balanced way. And so many symptoms. I mean that and honestly what most people don’t realize is so much of anxiety and insomnia which are really top symptoms. For it’s really related to caffeine and take. And it was like, yeah, but I only have one or 2 cups by 11 am. It doesn’t matter. It takes 24 hours to break that down. And as soon as they stop that, the anxiety and the sleep disturbance go away.

So it’s tough. Like, you know, we don’t, we don’t, we were ingrained with so much of this, habit, these sort of not great habits that we have. But when you Get rid of them. They make massive changes in your in your life. I mean, fatigue changes, mood changes. Headaches change, energy drops in the afternoon, all that goes away when your blood sugar is more stable for sure.

I will say the coffee is the one thing I have not given up yet, but I don’t feel like I need to, right? So I’m not, I’m not having symptoms. I’m not having sleepless nights. So. You know, just because someone says, you know, don’t have coffee and there are coffee alternatives I’ve tried, you know, mushroom coffee, everyday dose and most of them that are out there. I’ve settled on everyday dose, but I still I will add that to my coffee. But if you’re not having, you know, sleep issues, it doesn’t, you have to give up your coffee.

If you’re having sleep issues and you’re having headaches and you’re having hot flashes.

Correct. Correct. Correct. Yeah.

Then there might be a reason for you to give it up.

A 100% and that’s what I say. I tell patients if you have anxiety. Or sleep disruption. You must get rid of caffeine and alcohol to see at least see whether or not that’s the trigger. Give it 2 to 3 weeks. And C. If it doesn’t affect you, it doesn’t affect you. If you don’t have anxiety, you don’t have sleep problems, then you’re fine. Like you have no issues with that. But if you do, you need to…

Right. Right. So. One of the questions that came up in the chat was, and I don’t know if you know the answer to this, but are there different? Things being taught now. For traditional medicine doctors in terms of educating them more on female reproduction and hormones and menopause. Given that, you know, I think we said before a billion women will be in menopause by 2,025. Working with younger doctors, do you know if any If any of this is getting through to these medical schools, where doctors are getting a different education now or is it still the same text?

Yeah. Well, I, wish I knew the answer to that, you know, since I’m not, not really working in the hospital anymore, I don’t come in contact with the medical students or the residents to see, you know, what their training is like. From what I can tell, however, when patients come to me after they’ve seen another Gynecologist or practitioner who was young? It doesn’t sound, well, let me just give you an example.

I had a patient who I hadn’t seen in a couple of years. She doesn’t live close by anymore. So she was seeing another gynecologist. I had she had been on hormone replacement for a number of years. I think she was 60. She saw, this new younger gynecologist who said, you know, you really need to get off of that hormone placement therapy. And the patient was like, well, I’ve been on this for years. I feel really good on this. Why would I need to get? Because well, you know, it increases your risk of breast cancer. You really need to get off. And the patient was like, well, I. I would prefer to not get off. She goes, well, I’m gonna write you for a lower dose. She said, okay, I mean, I need a prescription. So if that’s what you’re willing to give me, I’ll take it.

She came back to my office. Basically, You’re practically crippled. She had diffuse body pains all over. She couldn’t. She couldn’t sleep well. Her brain fog was massive. 2 o’clock hit she had to have a nap. She was like, I don’t understand why I’m feeling this way. I said because you’re not on the right amount of hormone like you’re not And she didn’t let her take her testosterone. Okay. I mean, so if that’s any indication of what the younger generation is looking, it’s not looking good, you know, so. But I can’t, I don’t know what medical students, what medical schools are doing. I will say that. When I was last in hospitals, which was 7 years ago. The medical students were very pharmaceutically driven. They were very big into medicating everything with a medication. Not hormones, but they loved antidepressants. They loved antibiotics. You know, pain medication, like basically they would treat, you know, ambient, like any, any, every symptom had a different. Every symptom. Right. So, you know, the medical schools are unfortunately, you know, they’re funded by pharmaceuticals.

Right.

So that’s, that’s how they’re taught. So I’m not sure. I mean, I hope it is changing because patients and customers. If you wanna look at a patient as a customer, they’re demanding it. They don’t want that. They want something better. So.

I think this is a good segue into testing, right? So again, depending on what your age is, like what are some of the initial tests that you recommend people do in order to figure out if, you know, assigned from having symptoms if hormone replacement therapy is right for them and how much more hormone replacement there are, which hormones are right for them.

The gold standard really for most patients, would be in any age, thirties, forties, fifties, sixties. The gold standard is to do a serum testing, so that’s blood testing. The thing is that you have to you have to have knowledge about the timing of blood work if you have a woman who is still having her period, when is it that you want to try to test her?

Ideally it depends on what information you’re looking for. If you’re looking to see that her estrogen progesterone levels for peak levels are ideal, then you want to test her about one week before. She’s about to get the 1st day of her the 1st day of her period. That will tell you what her peak hormone level is. If you’re talking about someone in their forties, If they’re having regular periods, same thing. But you may also want to check her pituitary hormones, her FSH LH levels to see if they’re starting to rise because that coincides with the ovary becoming less sensitive to the request. From your brain to make hormones. In your fifties, I So. I don’t think that. I don’t necessarily use blood work. To decide if someone needs hormone replacement or not. Because you have women who stop getting their periods. For a year or two and they’re not symptomatic.

But they want the longevity benefits. I have women in their forties who are still getting periods but are having severe estrogen deficiency symptoms. And if the blood work doesn’t reflect that, I’m not going to withhold medication. For her. So, I use it as a way of, you know, number one trying to get a little bit of a sense of where someone might be, understanding that every day is different. Like one day you can be having hot flashes and night sweats and another day you can have breast tenderness and water retention because you just ovulated so you know, it varies literally from day to day if you’re if you’re still menstruating.

If your menopausal, which means that you’ve had no period for a year. In the right age group, which is usually over 45. Then by definition your estrogen, your estrogen progesterone, they’re going to be low. There’s almost no point in testing that because they’re low. I mean, they’re menopause. You’re not making that anymore. But But I do like to test testosterone and DHGA, which is an adrenal hormone that helps to support women.

When they become an apostle. So DHA is called sort of the anti-aging longevity hormone. It’s from the adrenal because it will turn into estrogen and testosterone and all these other things. But The important thing with serum is knowing when you’re testing it at different times of the cycle And for menopause, you want to be able to test all the hormones. And then I also like to see what the hormones do once we put women on hormone replacement to make sure that their levels are adequate enough to get the bone protection, the heart protection, the brain protection. And things like that. There are other tests like the Dutch test, which is very popular. That’s the dried urine test for, cortisol and hormones. So that tests your adrenal hormones. As well as your sex steroids estrogen testosterone and progesterone as well as all of the breakdown products. So I, I, if patients were willing to pay for that test, cause it costs about $350, it’s not covered by insurance. But what I love about that test is if you are on hormone replacement therapy, you can monitor to see how you’re breaking down your hormones and make sure that you’re breaking them down and safe pathways. So there are certain breakdown products of estrogen that can be a little more toxic to DNA and there are others that are safer and more benign.

So in the Dutch test, it gives you a pie chart of how much is the toxic one, how much is the safe one, how much is the intermediate one, and there’s the safe one, how much is the intermediate one, and there are certain percentages that you want to aim for. And so if I see that, I, I can manipulate that to make sure that women are, breaking down their hormones in a very safe manner. That’s not, to be honest, typical what I don’t typically run that test because most women are not willing to pay for tests like that. So, you know, you just do the best you can. And that’s it.

But, so okay, so I’ve taken that test numerous times. How often do you recommend people take that test?

A year, like every 6th month. So it depends on what the findings are. So let’s say that someone’s adrenal hormone are messed up and you wanna try to fix them and you’re into implementing some strategies to try to rebalance the adrenal hormones or let’s say that on the Dutch test you do have a higher percentage of the more toxic metabolites estrogen, the four hydroxy estrogen metabolites. Then I would institute some intervention to try to change that and then I would want to check that again, let’s say 3 to 4 months later. Adrenals don’t change quickly. So if I have somebody on an adrenal program, then I would want to test them maybe like in about 6 months. It’s not gonna change more quickly than that. If patients are on adrenal protocols, then, and they’re stable, but they continue to need them. Then we could test them once a year. Hormonally, if once they are in a more safe range, I don’t necessarily need to test them again, but you could keep an eye on that once a year once it’s stabilized in normal.

And so just. I mean, I’m an open book, so I really don’t care about sharing. One of the things I did prior to going on hormones was I started taking a DHA, I was taking a dim supplement so I started a supplement regimen. Prior to taking hormones. And so is that something, I guess, depending on. People is there and I don’t know if you’re comfortable just throwing out like yeah people should be taking a DHA. But is there something that people could do that are really uncomfortable still with taking a hormone?

So, I, definitely used to do a lot of adrenal programs to treat, hormone related symptoms. And it can be very successful actually but Essentially what you’re doing though is you’re just giving hormones that are upstream. In the biochemical process. And they’re being converted into estrogen and protesters. So like, you know, it your It’s sort of a little bit of a back door. To try to restore some hormones for patients, but there’s no question that if your stress hormones are out of balance, it’s going to create a lot of hormonal symptoms.

So if you can get somebody’s adrenal stress hormones into balance in their thirties or forties even their fifties. If that is one of the root causes of hormonal symptomatology, then it will correct it. You know, the adrenals are one source of hormone imbalance. Intestinal issues are a big source. Inflammation and toxins are another source. Food sensitivities and food intolerances are a source. So All of those things can end up causing hormone symptoms. So if you correct all of those imbalances, the hormones will rebalance and you won’t and you’ll feel better. So you can absolutely Correct menopausal symptoms or hormone symptoms with adrenal balancing if the adrenal is what’s wrong, if that’s what’s wrong with you.

I know it’s 8:30pm or it’s actually after 8:30pm. And I have a million more questions. I can throw your way. But for the sake of time and your time and I truly appreciate you giving us all your time tonight, this has been amazing. You know, just drop it in the chat if this is something that you would be interested in continuing to sort of sit in on or participate in. It’s definitely something that Dr. Sadaty and I have talked through. We’ve even talked through.

Putting together a program on balancing hormones. Where you would be given a prescription to go get a hormone test and then we would talk through different like what the testing numbers look like.

So we are interested to get your feedback on tonight’s conversation. I think as a just a great way to wrap this up. Is You know, is there is there I would say my piece of advice. To anybody that’s on this call tonight that is interested in learning more about their hormones and figuring out like how to start feeling better because I just want everybody on this call to know you don’t need to feel like sh*t. It doesn’t matter what age you are. We should all be feeling good. And so if, you know, hormones is the answer or lifestyle changes are the answer or the issues, there are answers. And there are some natural ways to do that so I guess if there’s if there’s something that you want to leave everybody with Doctor Sadaty what would that be?

I think that the main idea behind this talk in my mind was just to allow women to understand that they really should have very open conversations with their practitioners about the symptoms that they are experiencing. About what the options are for treatment and to and also if the practitioner is not open, then to what your thoughts are, what your research has been, what you’ve been educating yourself about, They don’t have other ideas beyond what has already been suggested that you try to find somebody who at least considers themselves a specialist in hormonal treatment. Or a menopause physician or menopause doctor. Because if someone at least acknowledges that they have expertise in that area, you may be more likely to get a more nuanced and broad approach to treating your symptoms. But you know, it starts with just even questioning or even handing your doctor some information or studies or a book or whatever, you know, that you think has been very enlightening and helpful and that It may demonstrate a way that you want out of your hormone situation.

So you have to advocate for yourself. You have to educate yourself. You have to find a practitioner that will be a partner with you. And You know, and certainly people like Haley who are working around the clock to bring this amazing information to all of you guys into our community is like a wealth of information and an amazing resource. And she’s really done it and seen it all. And and so really sort of communing with people like minded like that. So just don’t give up. Like don’t think that, you know, what you’re getting is the end of the line. It’s really not. You just have to find your right, your right tribe.

And then I was gonna add to exactly what you just said, which is you have to be your own advocate. And if your doctor that you’re currently going to is not giving you a really good reason why you shouldn’t be taking hormones then. Maybe it’s time to find another doctor.

Yeah, yeah, I mean, I hope it is turning around. I think it is. I think it is, but, Not soon enough. Like it’s not fast enough, so we have to kind of light a fire. Under people’s, you know. Offices to get them to understand that there’s a need and that There are other ways to think about managing hormones and and women’s health.

So…

Well, thank you very much. We have a lot of thank you’s in the comments. Thank you.

Thank you.

This has been wonderful. Eye opening and let’s see everybody on here tonight, so thank you.

Thanks for joining and stay tuned. More to come.

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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!