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The Clay Travis and Buck Sexton Show
Wellness Unmasked: Is Hormone Therapy Still Risky—or Just Misunderstood?
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- [02:42]
Dr. Nicole Safire
I'm Dr. Nicole Safffire and today's topic, well, it hits close to home. Today we are going to dive into one of the most controversial and misunderstood topics, medicine, hormone replacement therapy or hrt. As a woman, if you've been told that it's dangerous or unnecessary, you're not alone. We all have. But it's time to set the record straight because the science has evolved and the stakes for women's health are too high to ignore. And if you're a man listening to this podcast, let me tell you, while you are not going to go through perimenopause or menopause, I guarantee someone in your orbit is going to, because all women do so. You might learn a thing or two by listening here. So I, I would tune in because this will benefit you as well. The reality is, in medical school I was actually taught that it was bad, but I'm going to age myself just a little bit here. After nearly 20 years since I have graduated from medical school, I've learned that on my own, maybe to treat or to not treat perimenopause, menopausal symptoms, it's not as black and white as maybe we once thought. And one of the most common reasons that women who are undergoing breast cancer treatment know, oftentimes they have surgery, radiation, sometimes chemotherapy. When that is all said and done, if they have a hormone sensitive cancer, oftentimes they will be offered an oral treatment to decrease their risk of that cancer coming back. Well, that medication, the main side effect, it essentially thrusts them into menopause. And women sometimes say the symptoms are far too much, they can't deal with it and they're going to stop taking the medication. Now. As a young doctor, I was shocked that women would make this choice. They know the risk of their cancer coming back is slightly increased if they don't take that medication. But for them, what is the life worth living if they are unhappy, if they don't feel well? The older I have gotten, the more I have begun to understand that it's not really all about risk reduction when it comes to life. But quality of life being lived is equally as important. Sometimes physicians forget this. As patients, you have to be your advocate. You have to talk to them about your quality of life. Because if you're not enjoying life, we all only get One opportunity on this earth, you have to make the best of it. And one of the most frequently asked questions that I get, whether it's from a patient coming in for a routine mammogram or I'm giving a speech and I take questions from the audience, people want to know what's my personal opinion on hormone replacement therapy for perimenopausal symptoms. And when I tell them I support it, most are shocked. But I've gotten confident in my ability to declare my support for HRT because I refuse to let 20 year old flawed data disrupt the lives of so many women, myself included. And truthfully, it wasn't until my own personal experience that I decided to do a deep dive into the data. That is what I'm here to share with you. So last year I started having some symptoms of my own. They're very vague, but one thing was I had. I got a migraine. I've never had migraines. I'm not a headache person. I had them a little bit when I was a teenager, but that was it. As an adult, I don't get headaches. It's not my thing. But I got a migraine. And then on top of that, I just wasn't feeling well. I was feeling a little tired, a little achy. I have a very busy life. It's kind of attributing it all to that. I also have an autoimmune disease. So I immediately thought, oh no, my autoimmune disease is progressing. Turns out my ovaries are just taking a break. It may be a permanent break, I don't know. But I went to my physicians and I talked to them and I said, something's not going on with me or something's not right with me. Thankfully, my rheumatologist said, we don't think it's the autoimmune disease. I was also having some other symptoms that I talked to my gynecologist about specifically being dyspareunia. You can google what that means, but essentially means discomfort during intercourse. And so I had the foresight of, you know, the only other time I have felt this is right after I've had babies. And what happens right after you have babies? Well, your hormones drop immediately. So something inside of me was telling me this could all be related to hormones dropping because I've had three babies. I have felt this way three times before and it feels kind of similar. And that's what happened. Yep, my ovaries are on a break now. I'm not going to say I'M in menopause. I'm for anybody keeping track. I am pretty young to be in menopause. I am in my early 40s. But some people do go into menopause, early menopause, even late 30s, early 40s. But my hormones are down and so I wanted to talk about options. My gynecologist actually brought up HRT and immediately I got a little bit nervous. And that's when I said I need to do my own research to figure out what's my opinion on hrt, Is it right for me, what are the risks and benefits for me as an individual? Because not one person is the same as the other. Not we're all different. So we have to go back in the wayback machine to why we have this group. Think of HRT being bad actually exists. In 2002, the largest studies ever done on postmenopausal women, called the Women's Health Initiative, was terminated early. And this sent shockwaves all across the medical community. The study actually linked hormone therapy to breast cancer, stroke, heart disease and even blood clots. And the media headlines, they were terrifying. And subsequently hormone use by women plummeted. Here's the truth. The study largely flawed and has nothing to do with what we are talking about here over 20 years later. And I'll tell you why these people were more afraid of the clickbait headlines than to spend time to really interrogate the whole validity of the study and dive deep into why it was even stopped early to begin with. So this large study took groups of women and they separated them into two main groups. One group of women had combined estrogen and progesterone. The other one had just estrogen. Originally the study was supposed to have eight and a half years of follow up. But after a statistical signal was seen after a little over five years, they stopped the study. The decision was based on what's called a statistical threshold. And it was crossed for what they called the global index risk, which included they saw an increased risk of breast cancer, stroke, heart attacks and blood clots, like I already mentioned. But the absolute risk was very small. For example, the increased risk of Breast cancer was eight additional cases per 10,000 women per year. Statistically speaking, that is a very small. But for those eight women who got breast cancer, that's not small at all. Right, here's the issue. The average age of women in the study was 63. This is long past menopause. The average age for women to go into menopause is 52, meaning from early 40s to early 60s and everywhere in between. That's when most women go through menopause. If the average age of the woman in the study was 63, that means they were sampling 50s through their 70s. And these. This is not representative of the typical woman starting HRT who should be in her 40s or 50s. And by the way, being a woman and getting older are independent risk factors for breast cancer. So the older they are, they already have a higher risk of breast cancer just by age alone. And most participants in this study had underlying risk factors like obesity and cardiovascular disease. And by the way, obesity increases your risk of breast cancer, blood clots, strokes, as cardiovascular disease does. So it wasn't a great sample set. And it certainly was not representative of the women we're talking about who might benefit from hormone replacement therapy. Again, younger women, women who are actively trying to keep their health in check. And the problem wasn't just who they gave the hormones to, but it was also the hormones that they gave to these women. So, first, I want to talk about the two arms. The one arm with the estrogen and progesterone, because you have to have that balance there, but the other arm just had estrogen. But it was a very specific caveat. Only women who have had a hysterectomy or surgical removal of their uterus can have estrogen alone. Now, why is that? Well, it is an unequivocal truth that estrogen increases your risk of endometrial cancer. Endometrial cancer is a cancer that develops in the internal lining of your uterus. You have to have progesterone to balance estrogen, or else you will have an increased risk of. Of uterine cancer. So, again, the arm could only have been women who had estrogen if their uterus was removed. But the estrogens that they used in the study is specifically called conjugated equine estrogen, and it's derived from pregnant horse urine. Yes, you heard me right. Sorry, ladies. Science isn't always sexy. Yeah. Did you know there's a diabetes medication that's actually derived from the saliva of a Gila monster? And there's a common blood thinner that was derived from rat poison. Alas, these are how medications are. Some of them are medical marvels, and some of them are not so much more. Coming up on Wellness unmasked with Dr. Nicole Safire.
- [11:39]
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- [15:17]
Dr. Nicole Safire
But the thing with the conjugated equine estrogen is that it doesn't parallel the estrogen that our body makes and is very different from estrogens that are available today. These conjugated estrogens, they're a mixture of multiple different estrogens. Some are human identical and some are not. Metabolism is very unpredictable and if the estrogen wasn't bad enough, the progesterone that they used is a synthetic progesterone that in subsequent research after that big study, it's been proven to negatively impact lipid profiles, your mood, breast tissue and has also been shown to increase the risk of clotting and inflammation. So these hormones were not good and furthermore they were taken orally. What's the problem with taking these orally? Well, it, it undergoes what's called first pass liver metabolism and that means that you consume it and now the liver metabolizes it. But during that metabolism it increases the blood clotting factors and what's called a C reactive protein which creates inflammation. So these hormones were bad idea in an older, non representative, higher risk population. This is why I don't like the study. Now if we fast forward to what we have available today. Most commonly you have 17 beta estragile. This is a bioidentical estrogen that mirrors the body's natural estrogen. On top of that you don't take it orally. It's available in transdermal patches, gels, sprays and this avoids the liver metabolism and therefore has a lower clotting and inflammation risk. Additionally we have what's called micronized progesterone. It's a bioidentical just like your body makes and it's safer for the breast tissue and the cardiovascular profile, and has also been associated with fewer mood side effects and better sleep. And as someone who diagnoses breast cancer every day, it's really important for me that this transdermal estradiol and the micronized progesterone combo in a big study did not show increased breast cancer risk in later observational studies. Great news. So while all the headlines said perimenopausal, menopausal hormones are bad, you should not consider hormone replacement therapy. It's not that the hormone hormones are dangerous, maybe the hormones used in that study, but it was really just that it's the wrong hormones were given the wrong way to the wrong people, and those results were unfairly applied to everyone. Today's hormone options are safer, smarter, and they're tailored to the unique risk profile. You can go to your gynecologist or your precision medicine doctor and they can take a blood test, they can see exactly where your markers are, what your level's at. It's not a one size fits all that can give you what you need to make you feel better. We have learned from the past and we cannot let it paralyze the present. Absolutely not. And if we fast forward to today, many reanalyses and newer studies, they've all flipped the script. We now know that when started within 10 years of menopause or before the age of 60, HRT can actually reduce alcohol's mortality, meaning reduce everything, essentially, that can cause death, lowers heart disease risk, improves bone health, stabilizes mood, improves our sleep, protects our brain health our cognitive function, decreases our risk of dementia, and most importantly, it's making women feel better and is doing it safely. So, like I said, every woman is going to face perimenopause and menopause. Some women really struggle through it, have severe symptoms, other women have no idea it's happening. And the only reason they know it's happening is because they no longer get a period. But here's the issue. Let's talk about what happens if you don't treat the natural estrogen loss that happens with age. Estrogen isn't just about getting your periods, menstrual cycle and getting pregnant and all of that. It also protects our bones, our brains, our blood vessels, our skin and our mood. Without it, women are significantly at higher risk of osteoporosis and bone fractures. Heart disease, remember, that's the number one killer of women, not cancer. Cognitive decline and Alzheimer's disease. Women are more likely to get Alzheimer's. Why is that? Because when you Have a decrease in estrogen, you have an increased risk of Alzheimer's, anxiety, depression, poor sleep, painful intercourse. All of this can go along with a decrease in estrogen. It's important to talk to your doctor about replacing that. Not just because you want to avoid hot flashes. Some people, some women actually take it as a medal of honor or badge of whatever, saying, oh, it's not that bad. I can muscle through it. But should we be muscling through it? It's not weakness. Going to your doctor and asking for these hormones. Okay, I understand. We all like to muscle through things. I am guilty of it myself, but it is so much more. Estrogen is needed for so many more things. As we get older, our bones just stop mineralizing. We get weaker. You see those little old women who are slumped over and their backs are curved and they have spinal fractures or broken hip and all these other things that have a huge risk of mortal. That is because of estrogen loss. Now, of course, hrt, it's not for everyone. Not everyone can go out and just start taking these medications. Women with active breast cancer, untreated blood clots, liver disease, as I said, women who have a uterus, you can't just go out and start taking estrogen. One way to offset that and balance the estrogen is to have a progesterone IUD or take a balance, take that micronized progesterone. You can talk to your doctor about it. Women with active breast cancer, untreated blood clots, or liver disease, unfortunately, may need to take a different approach to manage some of these symptoms and reduce their risk of illness. Because taking estrogen can have negative effects on them. That's why we individualize care. This is not a one size fits all conversation. And even if you can take HRT or you can't take hrt, there are still a lot of other things that you should be doing in everyday life in addition to hrt, to live your healthiest life. One of the biggest things we are what we eat. We have to focus on anti inflammatory nutrition. I didn't focus on this in college, in medical school, the. The only time that I really started learning about what I consume and what my family consumes is after I was diagnosed with an autoimmune disease. So anti inflammatory nutrition are foods that are high in omega threes, like fish, specifically salmon, big leafy greens, berries. You can google all the things you want. You can follow me on Instagram. I like to do a lot of cooking there. I'm also a big advocate for natural herbs. That's why I created Droprx, the liquid nutraceutical line, because I heavily support people taking like Trestrus, tribulus, turmeric, makaroo, ashwagandha. These can help with everything from hot flashes to sleep to sexual desire and everything in between, decreasing inflammation, all that stuff. It's essential that we take magnesium and vitamin D to keep our bones strong. And also it helps with our mood, sleep, hygiene, stress management, all of those things. I know you're kind of like, yeah, yeah, we've heard this all before. But the reality is, if you are not getting quality sleep, you are not going to be fine during the day. It doesn't matter if you can just power through it. Your body and your brain need that reset every single night. You should be prioritizing your sleep just as much as you're prioritizing getting your mammogram or your colonoscopy or anything else, because sleep is essential. And stress management. So many disease, cancer, cardiovascular disease, are all linked to stress, the high cortisol levels. And as we go through menopause and we have all these hormonal fluctuations, managing our cortisol is a big deal. One thing you can do, decrease your stress level, find things that you enjoy, because chronic stress actually accelerates your estrogen decline. Maybe that's why my estrogen declined so quickly in my life. I don't know. I'm busy all the time, but I actually really enjoy my life. That's where I'm saying that in jest. One big thing for women. And I'm not going to go deep into this right now because I think we're going to do a follow up episode to talk about this. But strength training and resistance exercise, absolutely crucial in perimenopausal and menopausal women. You hear all these stories, see all of these reels online about women wearing those weighted vests and just walking around. I mean, that itself is a new badge of honor for women in their perimenopausal age. I admit I do not have a weighted vest, but I may, I may be purchasing this soon because I've been reading a lot about them. The reality is building muscle also protects your bones. It helps regulate your insulin, and it's crucial for your brain health too. And you, you wouldn't expect that. But yeah, the more muscle you have, the more oxygenation you have, the stronger your bones are. It all comes together. It's like the circle of life and the Lion King it all. It's not just one thing. You don't just work out for your muscles, you work out for your brain, for your heart, health for your family. Because you're going to be around longer for your family. So here's the unmasked truth. Hrt, when used correctly and started at the right time, can protect women, not necessarily harm them. It can significantly improve their quality of life and even prolong their life disease free. It's important though it is started early. If you start it after you've gone through menopause, the risk benefit may not be nearly as there. The earlier start, probably the more benefit you will get. So it's time to strip away that fear, the outdated headlines and the one size fits all thinking. Because when it comes to hormonal therapy and women's health, it's time we start making decisions based on fact and not fear. Thanks for listening to Wellness unmass on America's number one podcast network, iHeart. Follow Wellness unmass with Dr. Nicole Safire and start listening on the free iHeartradio app wherever you get your podcasts and we will catch you next time. Gatorade is the number one proven electrolyte.
- [24:56]
Unknown Speaker
Blend designed to hydrate better than water.
- [25:00]
Dr. Nicole Safire
So you can lose more sweat and raise your game.
- [25:06]
Unknown Speaker
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- [25:35]
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