The Myths about Hormone Therapy - A Wake-Up Call to Get Wise!

Ever felt dismissed by doctors when discussing menopause symptoms? You're not alone!

Welcome to our first episode under the freshly rebranded title, The Menopause Disruptor Podcast. In this episode, we learn why host Mary Lee change her podcast name to better fit the mission to challenge societal norms and shift outdated perceptions around menopause. It's time for a shake-up to build a culture of understanding, acceptance, and empowerment. 

In this monologue, Mary emphasizes the importance of empowering women through education and accurate information, specifically regarding hormone replacement therapy (HRT), also referred to as Menopause Hormone Therapy (MHT). She delves into the controversial 2002 Women's Health Initiative (WHI) Trial, highlighting its flaws and subsequent misinterpretations that have long impacted the knowledge around the benefits versus the risks of HRT / MHT. 

Mary advocates for informed decision-making, urging listeners to actively seek current, evidence-based research to make the best health choices with their providers. This episode is a call to arms for women to reclaim control over their menopause journey and disrupt the lingering myths that continue to undermine women's health.

To access The North American Menopause Society (NAMS) 2022 Position Statement, visit https://menopause.org/wp-content/uploads/professional/nams-2022-hormone-therapy-position-statement.pdf

Transcript

New name, same game, but edgier!

Welcome to the Menopause Disruptor Podcast, formerly known as All Things Menopausal. And I'm your host, Mary Lee, a fierce menopause doula and licensed menopause champion, ready to challenge societal norms around menopause.

It's time to disrupt the harmful and inaccurate narrative and reclaim our voices. And this is why I needed to change the name to better suit my mission and the platform of our show. 

Since we launched one year ago, I have had the honour and pleasure to interact with so many incredible, smart, and determined women from all walks of life.

But sadly, I hear the same heartbreaking story time and time again. Women are being dismissed, gaslit, and outright ignored by their physicians. There's a desperate need to change in how menopause is discussed. and understood and not just in the medical circles, but in society at large Misogyny in healthcare and the systemic dismissal of women's symptoms during midlife is an ongoing battle. it's time we unite our voices. We need a platform that isn't just about education, but about actively disrupting these outdated perceptions. Menopause is often shrouded in stigma, misunderstanding, and limiting beliefs perpetuated by the medical community and the media, but here's the truth.

Hormonal change is a natural part of life, and it deserves to be embraced, understood, and celebrated. Thank goodness we are witnessing a remarkable surge in attention to women's hormone health, and this is fueled byinfluential celebrity figures, forward thinking and educated medical practitioners, politicians, so many more who are openly discussing this crucial stage of life.

This newfound visibility is empowering women everywhere to take charge of their health and well being. And I've joined the ranks, honed my skills and sharpened my tongue to advocate for your autonomy in health care and ensure that you receive the dignity and respect. You deserve during this transformative journey. 

Through my business, Emme Elle Coaching, and this podcast, I aim to empower women who are navigating the turbulent waters of peri to post menopause with a wealth of knowledge in hormonal health, nutrition, Holistic Living. Each week we'll tackle the taboo topics surrounding menopause with grit and honesty.

I'll be diving deep into everything from hormone replacement therapy to nutrition, sleep, libido, and often ignored aspects of heart, brain, bone, and pelvic health. No longer will we accept vague answers from the medical establishment. We'll arm ourselves with evidence based research. to ensure we get the quality of life we deserve.

And just as I have done for the past 12 months, I will continue to bring on the experts in the field of women's health and wellness who share my passion of elevating women's health and challenging the status quo. Together, we are debunking the myths and empowering you to advocate for your well being with confidence. 

It's time to disrupt these damaging and limiting beliefs around menopause and rewrite our stories. join me on this empowering journey where we aren't just surviving. We are thriving. Tune in and let's make some noise. 

The very first episode I want to do under this new nomenclature is to disrupt a topic that has been shaken up many times before, certainly among the leading experts in the field of women's health, and they include Dr. Abram Blooming, Dr. Sarah Gottfried, Dr. Jen Gunter, Dr. Lisa Mosconi, and several others, including menopause intelligent healthcare providers in my local community.

And that topic is the Women's Health Initiative Trial. The WHI trial findings reported in 2002, significantly influenced perceptions of hormone replacement therapy, otherwise known as HRT, as we see in Canada, menopause hormone therapy, MHT, and ultimately this resulted in a drastic reduction in the use of HRT.

Estrogen therapy among women who are throwing out their estrogen left, right and center. However, this study's conclusions have been called into question several times since By subsequent analysis, highlighting critical flaws in its methodology and in its reporting.

And the reason why I want to bring this monologue to you today is because I have been in a couple of trade shows now and I've certainly worked with women and I hear it amongst certain circles of women And that is the ill reporting of the findings from the WHI, which still to this day, the ghosts of those headlines linger.

And unfortunately, a lot of our medical community hang their practice on that, refusing to prescribe hormone therapy. Or not well educated enough, and that's a well known fact Very few are fully educated unless they take it as an additional education course curriculum beyond their initial internship to become certified

So firstly, let's take a step back and understand why the woman's health initiative trial was on in the first place. And just to summarize it, it was to determine.

Unilaterally, with enough research and data, that estrogen therapy did indeed reduce the risk of cardiovascular diseases by up to 50%. So that was the goal that they set out in mind. But they put in safety factors, they built those safety factors in just to take a look at other issues such as stroke and breast cancer. the WHI clinical trial enrolled more than 68, 000 postmenopausal women who were between the ages of 50 and 79. (Note: only ~27,000 enrolled took part in the trial). The average age of these women was 63, many of whom are well past the ideal window for HRT, which is typically considered between the ages of 50 and 60. So, this discrepancy alone raises concerns about the applicability of its results to the broader population of women who would actually seek HRT at the onset of menopause and at the age where it would be appropriate to do so.

Okay, so secondly, the preliminary results shared by the National Institute of Health who commissioned this study, during a press conference, put emphasis on an increased risk of breast cancer, creating a significant population backlash against HRT. I mean, it hit headlines. It was on the morning news. It was on the Good Morning America. The damage was done, but, but subsequent analysis indicates that the so called 26 percent increase Represented only a rise from 30 to 38 cases of breast cancer per 10, 000 women annually. Now, if you would hear increases the risk of breast cancer by about 26%, that's huge.

It's huge if you have a population of 100, but see, it was a larger population size. And an additional eight cases or less than one extra case per thousand women is not a The dramatic increase that it had been interpreted to be at the time. Moreover, and this is interesting, there was evidence from the study that estrogen alone was associated with a decreased incident of breast cancer and a 30 percent reduction in overall mortality among those who took it, a finding that received far less attention in the media.

In essence, while the WHI initially cast doubt on the safety and efficacy of hormone therapy, resulting in like a sharp decline in its use, later commentary from the study's investigator had suggested that, oh gee, HRT, especially when initiated in younger women, may indeed offer the health benefits that we were looking for, but we overlooked to share in the study.

Oh my goodness. So in summary, the WHI findings and their aftermath reflect a serious misinterpretation of data and an inappropriate application to populations of women for whom HRT could be significantly beneficial. And it's because of this miscommunication that has led to a considerable gap in adequate menopause care and understanding of hormone therapy's role in women's health.

Even to this day, because the ghosts of those headlines, they linger, and I know there's many physicians that probably didn't even come on board until post 2002, but it's in their curriculum perhaps, or it's just in the way they talk amongst each other. This lack of education and coming up to speed and moving with the times, they are still stuck on 2002 findings and haven't moved the yardstick forward. Or just simply have no education in menopause and hormone health for women. 

Okay, now that we've clarified the issues with the WHI study and called it out for its inaccuracies, we still have to contend with the fact that these lingering myths about hormone replacement therapy and menopause hormone therapy, particularly among our Medical professionals, as I just said, still echo and that sentiment that made headlines 22 years ago are leading to this misconception around hormone therapy being good versus being bad.

But the Menopause Society has outwardly addressed in their 2019 position statement, and then again in their 2022 position statement, the safety and efficacies about HRT. Now, I just want to preempt right here, that as a menopause doula, I cannot prescribe, I cannot diagnose.

I'm not pushing HRT, and I'm not against HRT. What I'm here for is to gather the credible information, scientific data, and the research to provide you With that information so that you can make an informed decision with your health care provider, your health care team about what options are best for you and managing your symptoms to get a quality of life.

But it makes me very upset. When I hear women engage in that conversation, that was so damaging to the female population 22 years ago, because they're either hearing it still on social media maybe, or with their doctor, or they haven't been properly educated and brought up to speed, with other studies and subsequent reports that have debunked everything that came out in those trials in 2002.

And so I really want to disrupt that. That perception and change the way that you too as women think, act and treat your menopause with respect to HRT. My best advice and my wish for you is to practice discernment. 

Okay, so now here are some things you need to know. The safety of HRT or MHT. Hormone therapy is considered safe for most women who have symptoms. Now there are contraindications that exist and you need to work them out with your doctor and they include a personal history of breast cancer, not your mother's, not your grandmother's, your personal history of breast cancer.

Certain types of cancers, recent blood clots, or liver disease, or other cardiovascular events. Those would be contraindications that would not make you feel better. Viable for taking HRT, but that is a discussion to have with your doctor Two myths about symptoms Okay So some women wonder why would I take HRT or MHT if I don't have symptoms like the classic hot flashes mood swings?

Vaginal dryness now it has been clarified and certainly within the position statement of the menopause society and many other subsequent research findings that even Asymptomatic women should consider HRT As it can still provide significant health benefits, particularly if started within 10 years of menopause.

And those health benefits include reducing the risk of osteoporosis, protecting against heart diseases, and may also protect against significant cognitive diseases such as dementia, and improve overall brain health.

Misconceptions around muscling through it or that HRT is a pharmaceutical and that all pharmaceuticals are bad because there's Synthetics and therefore those chemicals are not natural nor safe for our bodies Okay, so first of all the muscling through it idea the idea is That we must endure through menopause symptoms without treatment needs to be challenged, because there are, again, if you're asymptomatic, there are still significant benefits to be had with being on an HRT, and again, those benefits outweigh those risks.

So whether you're feeling symptoms or not, and you feel that HRT is not good for you because it involves a synthetic chemical, well,I will say that this oversimplification overlooks key factors. And these key factors to consider is the differentiation of hormones, comprehensive research and regulation that goes into hormone therapy studies, individualized treatment plans, quality of life improvements, and comparison with other medications.

And I'm going to get into each of these one at a time. First off, many hormone therapies include a bioidentical hormone, which are chemically identical to human hormones that are often derived from natural sources, making them more compatible with the body. Second, HRT is extensively studied and regulated by bodies like the FDA and here in Canada, Health Canada, and its risks and benefits are well documented, ensuring that patients receive safe and effective treatment.

HRT can be tailored to a woman's specific health needs with individualized treatment plans, which helps mitigate risks and enhance its overall treatment effectiveness. HRT provides significant quality of life by giving relief from some even debilitating menopause symptoms such as hot flashes and mood swings, and of course, 

By having a better overall quality of life, a woman can feel back in control so she doesn't have to give up on so many things that bring her joy, like her hobbies, her sex life, yes, let's face that, and even her job and herself. 

And then the last point is this, this comparison to other medications. Yes, many medications contain synthetic components to improve its efficacy, stability, and even its deliverability. But each medication's risk benefit profile should be evaluated individually rather than rejecting an entire class based on composition.

So, While concerns about synthetic chemicals exist, HRT is not simply a negative pharmaceutical solution. Its variety of options, its personalized treatment, its regulation, and the benefits for women during menopause highlight that HRT MHT can be safe and effective when properly managed.

But discussions should focus on informed choices in individualized care, rather than a complete dismissal by your doctor or your healthcare team based on its synthetic nature, or a whole host of other reasons that we've already talked about, such as The risks of breast cancer, again, the position statement and subsequent findings since the 2002 trials have revealed that the benefits on average for most women outweigh the risks, unless there are pre existing conditions, contraindications.

So conversations about whether to MHT or not MHT. It's really a conversation that requires openness among women regarding their hormonal symptoms. and of course, what they can do about it. More importantly, though, is that we need to advocate for access to reliable and current information from our health care providers so that we can get the support.

This is so critical. We all have to strive for a cultural shift in how menopause is thought about, acted upon, and ultimately treated.

So, I can't emphasize this enough as a licensed menopause champion, an educator, and a menopause doula, that shared and informed decision making regarding MHT rests with the public. A woman and her healthcare provider, her GP, her naturopath, whomever you have on your healthcare team. Now, recognizing it's not always easy to get that conversation started, particularly if you're up against a medical practitioner or a community of medical practitioners who still are echoing the sentiment of 2002 trials.

Getting that conversation started can be very difficult. So I ask you this, rather than suffer in silence, or wait for some change to come along that is external to you, or hope this phase in life will pass, which quite honestly can last up to 10, 12 years or longer for some women, why not take agency of your menopause today and get the help that you need and the quality of life that you deserve?

I hope that this little disruption of your thought process, your perceptions towards MHT, has really caused a bit of a shake up and has allowed you to look at things from a different lens, particularly if you're just really feeling like HRT is not for me. and that's not always the case. Have that discussion with your doctor, and if you can't get there, well, recruit the support of a menopause doula.

Because not only do I help access current, reliable, incredible information on women's health and menopause symptom management, I can help you advocate for your health by arming you with the most current and reliable information and developing a plan. And a list of questions that you can go forth and discuss with your health care team, your health care provider.

That's what a doula can do for you. Again, my wish for you is to practice discernment. We are wise women stepping into the age of wisdom. So let's get wise. Let's get educated.

Knowledge is power and power is the difference between you deciding for yourself or somebody else deciding for you. remember midlife should be the best life and it will be. Namaste. 

 Wait one second. Before you go, there's one last thing I want to share. This is important.I don't want your menopause to limit who you are at this pivotal stage in life. I also don't want you to feel stuck in your transition with no clue where to begin. So, I developed a program to help you on the journey. It's called, None other than the menopause intelligence course, take control of your journey and invest in your future with knowledge, support, and the skills to thrive.

I'd love for you to join me on an enriching transformative experience designed exclusively for individuals ready to take agency of their menopause and not be slowed down in the symptoms and in their experience. Here's what you can expect from the course. This is a self paced learning journey.

This eight module course is fully self directed, allowing you to learn at your own pace. Whenever it suits you, dive deep into the material when you're ready and revisit them over and over again, whenever you need. These modules are specifically crafted to explore essential aspects of the menopausal experience, blending scientific insights with practical strategies to empower your decision making.

This is the perfect intersection of science and spirituality. We explore the science of hormones and the resulting mental, emotional, and physical changes associated with hormonal fluctuations. We also cover a range of holistic strategies and practices, inviting you to tap into your inner wisdom for symptom management.

You'll be empowered to learn. to make important health care decisions. I'll teach you how to have those crucial conversations with your doctor about menopause, hormone therapies, and other treatments. You deserve to have your voice heard and to participate actively in your health journey. 

Experience the power of shared decision making together with your health care team, you'll craft a personalized management plan that respects your unique needs and values. And I'm going to show you how to ask exactly for that. Say goodbye to feelings of shame, embarrassment, or isolation.

Own your journey, gain mastery over your menopause experience, face symptoms with confidence at work, at home, and in your community, transforming what can be a challenging time into an opportunity for growth and celebration. Now, here's why I believe this course is for you. Quality of life. We should all prioritize our well being and feel good about ourselves inside and out.

This course is a permission slip to do just that. It isn't just about managing symptoms, it's about enhancing your overall quality of life with knowledge and purpose and a fresh new perspective on your menopausal transition. There's no misleading information. Everything I provide is backed by evidence based research and science.

And I provide a safe space free of misogynistic views, gaslighting, or white coat syndrome. Just honest guidance and support. This course is also an opportunity to celebrate your transition, embracing this natural progression and transforming it into a period of strength.

learning and personal empowerment. There is a reason why Ayurvedic philosophy recognizes menopause as the age of wisdom. You're a wise woman. So let's get wise together. Head on over to the link in my show notes to learn more and enrol today. I can't wait to have you be a part of this community.