The Heat is On

It is not uncommon for us to meet a patient in our office that is a woman in her 40’s or 50’s complaining of frequent joint pain. As we dive into her medical history, we may also find she has been to a therapist for depression, she isn’t sleeping well (night sweats and hot flashes), and is gaining a bit of weight. Instead of dealing with the issue (Menopause), too often only the symptoms of the issue are treated. The history of hormone replacement therapy (HRT) in women is a fascinating one, so we thought we would dive in for this next podcast/newsletter.

Just as in our male hormone episode, we begin by discussing how the various hormones flow, only now it is a monthly cycle of ups and downs. A big takeaway is that it is during the follicular phase (day 0-14) of a woman’s cycle where FSH is acting on the ovaries to secrete estrogen and you will see a large spike in estrogen leading up to ovulation. Getting blood work done in a standardized time of the cycle is generally recommended, and we have read that day 5 of the cycle is a good time to do this to measure FSH and Estrogen levels. As menopause sets in, you will see FSH levels rise, but estrogen levels really drop as the brain is trying to stimulate more estrogen production, but the ovaries are not doing it.

We then get in to the Women’s Health Initiative Study which is where the use of HRT for women to help with the symptoms of menopause changed, perhaps forever. In 2002 they stopped the study because they claimed that using HRT increased a woman’s chance of breast cancer by 26%. This is what the news reported and subsequently the number of women using HRT plummeted. However, what we find is when you really dive into the study, a completely different picture emerges.

This increased risk was not statistically significant, meaning we can’t be sure it wasn’t just due to chance. The women studied had an average age of 63 (past menopause), most of whom were overweight or obese, over 50% of them were smokers, and many had hypertension. Hardly a healthy group to study. Many women who were experiencing symptoms of menopause were excluded from the study. Many women in the placebo arm of the study (women who were not getting HRT during the study) had a past history of using HRT. This may have lowered their chance of developing breast cancer, thus making the treatment arm of the study appear worse. There were so many issues with this study, the book we reference in the podcast (listed below) is truly an interesting read.

We end the podcast discussing some of the benefits various studies reveal regarding HRT. There is a study stating that if every woman in the US was on HRT, it would increase the median survival of women by 3.3 years. It can decrease the risk of bone fracture by 50%. It can reduce the risk of Alzheimer’s by 20-50%. It can reduce the risk of colon cancer by 20-25%. There is some truly amazing data out there on HRT’s health benefits (links below). As always, this information is meant to inform and perhaps begin a conversation with your doctor if needed. There are good reasons to not begin HRT, but we can at least be more informed.

Give the podcast a listen here… Apple Spotify Google Amazon

Simplified Takeaways…

1. During menopause, a woman’s estrogen doesn’t just gradually decline over the years like a man’s testosterone. It can plummet to around 1% of normal estrogen levels.

2. There are many symptoms of menopause, such as: hot flashes, night sweats, weight gain, depression, poor sleep, fatigue, brain fog, and joint pain. The problem is these symptoms can lead women down a number of different rabbit holes.

3. Getting blood work done on a consistent day of the cycle is a good idea. Generally day 5 of a woman’s cycle is recommended to get a good view of how Estrogen is doing.

4. The Women’s Health Initiative is a deeply flawed study. The findings reported from this study sharply decreased the number of women on HRT.

5. The headlines of this study also distract people from the many benefits the literature reports on the use of HRT. Not only reducing or eliminating the menopause symptoms listed above, but also reducing the risk of colon cancer, bone fractures, Alzheimer’s, and even heart disease.

Further Reading…

1.  The book that we reference in our podcast. It is a great read.

2.  Study showing HRT could increase median survival of women by 3 years.

3.   Study showing estrogen can reduce the risk of Alzheimer’s.

4.  Study showing estrogen can decrease risk of bone fracture.

5.   Study showing estrogen can decrease risk of colon cancer.

Disclaimer: This newsletter is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advise. No doctor/patient relationship is formed. The use of information on this newsletter or materials linked from this newsletter is at the user’s own risk. The content of this newsletter is not intended to be a substitute for professional medical advise, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advise for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions.