Podcast Summary: The Tamsen Show – "Hormone Therapy for Menopause: What Every Woman Should Know"

Introduction to Menopause and Hormone Therapy In the episode titled "Hormone Therapy for Menopause: What Every Woman Should Know," host Tamsen Fadal engages in a comprehensive discussion with Dr. Sharon Malone, a renowned OB/GYN and menopause expert. The conversation delves into the complexities of menopause, the historical context of hormone therapy (HT), and the lingering misconceptions that affect women's health decisions today.

Historical Background of Hormone Therapy Dr. Malone provides a detailed history of hormone therapy, tracing its origins back to the FDA's approval of Premarin in 1942. She explains how hormone therapy was initially promoted for symptom relief and later for its purported long-term health benefits, such as reducing cardiovascular disease and osteoporosis risk.

“Estrogen was approved by the FDA in 1942… initially used for symptom relief, and later for long-term health benefits like reducing cardiovascular disease.” [26:27]

She highlights the pivotal role of Dr. Robert Wilson’s 1965 book, Feminine Forever, which controversially marketed hormone therapy as a means to preserve femininity and sexual attractiveness, leading to a significant increase in HT prescriptions.

Impact of the Women's Health Initiative (WHI) Study A turning point in the perception of hormone therapy was the 2002 Women's Health Initiative (WHI) study. Dr. Malone criticizes the study's design, noting that it included older women (average age 63) well past menopause, which skewed the results against HT by associating it with increased breast cancer risk and lack of cardiovascular benefits.

“They skewed it such that the women were much older at the start of the study… the average age was 63, which was not typical of who we normally prescribed hormones for.” [36:13]

The immediate media fallout from the WHI press conference led to a dramatic decline in HT usage—from approximately 38% of eligible women to less than 6%—a trend that persists decades later.

Understanding Perimenopause vs. Menopause The conversation distinguishes between perimenopause and menopause, clarifying common misconceptions:

• Perimenopause is the transitional phase leading up to menopause, lasting anywhere from four to ten years, characterized by fluctuating hormone levels and symptoms such as irregular periods, mood swings, and brain fog.

  “Perimenopause is defined when you are having symptoms and you are between the ages of 35 and 45.” [06:07]

• Menopause officially occurs after a woman has gone a year without a menstrual period.

Dr. Malone emphasizes that blood tests are unreliable during perimenopause due to hormone fluctuations and advocates for symptom-based diagnosis and treatment.

Efficacy and Safety of Hormone Therapy Addressing fears about HT, Dr. Malone explains that the increased risk of breast cancer from HT is significantly lower than lifestyle-related risks, such as drinking two glasses of wine daily or being overweight.

“The increased risk of you contracting breast cancer on HRT is less than the increase in the risk of breast cancer from drinking two glasses of wine a day.” [61:56]

She advocates for the safe use of hormone therapy, particularly low-dose options and transdermal estrogen, which pose fewer risks for blood clots compared to oral forms. Dr. Malone asserts that HT can be used as long as needed, especially for preventing osteoporosis.

“How long can you stay on hormone therapy? As long as you like.” [63:08]

Addressing Ethnic Disparities in Menopause Experience Dr. Malone discusses how menopause affects women differently across ethnic groups. African American women, for instance, experience menopause earlier, endure more severe symptoms, and are less likely to receive HT despite greater need.

“African American women tend to go through menopause earlier... their symptoms start earlier, they're more severe, they last longer, and they're the least likely to get a prescription for medication.” [48:42]

She calls for better education and inclusion in medical research to ensure all women receive appropriate care.

Navigating Menopause Today The episode underscores the importance of self-advocacy and informed decision-making for managing menopause. Dr. Malone encourages women to maintain a healthy lifestyle and consult knowledgeable healthcare providers about hormone therapy options tailored to their individual needs and health profiles.

“You have more control over how you age and how you age healthfully than you think… The more you know, the better you're able to advocate for yourself.” [68:21]

Key Takeaways and Advice for Women Dr. Malone offers practical advice for women approaching menopause:

1. Consult with Healthcare Providers: Discuss whether hormone therapy is appropriate for you and consider your family history and personal health risks.

2. Focus on Overall Health: Maintain a balanced diet, regular exercise, and healthy weight to mitigate menopause symptoms and long-term health risks.

3. Educate Yourself: Understand the differences between perimenopause and menopause and the benefits and risks of hormone therapy.

4. Advocate for Inclusion: Support and demand more inclusive research that represents diverse populations to improve menopause management for all women.

Conclusion: Empowering Women Through Knowledge Tamsen Fadal and Dr. Sharon Malone conclude the episode by reinforcing the message that menopause does not have to be a period of uncontrollable suffering. With proper knowledge and proactive healthcare, women can navigate this life stage with confidence and maintain their quality of life.

“You can stop feeling stuck and start taking charge… this is your moment.” [Final Remarks]

The episode serves as a valuable resource for women seeking to understand hormone therapy and make informed decisions about managing menopause, emphasizing the importance of accurate information and personalized healthcare.