Real Food Stories

108. Unraveling the Confusion Around Menopause Hormone Therapy

• Heather Carey • Season 4 • Episode 108

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This episode dives deep into the confusion surrounding menopause hormone therapy, discussing the historical stigma, outdated research, and contradictory medical advice women face. By understanding these complexities and advocating for themselves, women can navigate their menopause journeys with more confidence and clarity.

• Examination of outdated beliefs about hormone replacement therapy
• Discussion on the impact of the WHI study on public perception
• Insights on the inconsistencies in medical advice from doctors
• Analysis of misinformation in digital spaces, including social media
• Exploration of compounded hormones versus FDA-approved therapies
• Overview of emerging changes in menopause care, including specialization
• Suggestions for women on how to advocate for themselves
• Emphasis on the importance of community support and education

Links Mentioned in The Podcast
Menopause Society click HERE
International Menopause Society click HERE

Books I Recommend
Menopause Manifesto by Dr. Jen Gunter
Estrogen Matters by Dr. Avrum Bluming
You Are Not Broken by Dr. Kelly Casperson

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Hang out with Heather on IG @greenpalettekitchen or on FB HERE.

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Speaker 1:

Hello everybody and welcome back to the Real Food Stories podcast. Today we're diving into a topic that so many women are frustrated by, and I thought it was important to address this because I talk to and coach many, many women in midlife and going through the menopause transition, and the frustrating and confusing thing that we're going to talk about today is hormone replacement therapy, which is now called menopause hormone therapy, only just to add to our confusion. Now, why is there so much confusion about menopause hormones in general? And I know I've talked about this in great detail on this podcast. I even have a whole course on this topic called Nourish your Menopause Journey, which, by the way, is relaunching in March, and if you didn't take it the first round, please consider taking it again. It will give you the clarity and confidence and, I think, peace of mind you need about your menopause journey.

Speaker 1:

But back to hormones. Why is there so much confusion about hormones in general? If you asked your friends a few years ago, it was very taboo to say that you were even on hormones. I had almost no friends sharing the space with me back then. No one talked about it and hormones just seemed risky. I would have hoped by now that women are past this fearful thinking and I know that we can talk more openly about being on hormone therapy. It's much more accepted now and women are more than ever open to trying it, because hormone therapy is really your best solution for so many menopause symptoms and perimenopause symptoms. It is well-tested, it's well-studied and I'll say it again, if I have to get past that old, outdated study from the 2000s, it's been debunked. So my question is why do some women get completely different advice from their doctors, their friends or even what they read online?

Speaker 1:

This is where the confusion begins and ends. Honestly, I think it's kind of a mess. I had one friend of mine who has been using hormones for a few years just tell me that her doctor told her to go off of hormones now that she is 60, while I have two other friends who literally just started taking menopause hormone therapy and they are both 61. Some doctors prescribe compounded hormones despite clear evidence that they are not safe, and others stick rigidly to outdated guidelines. I'll say this again it's confusing, it's frustrating and it leaves us wondering why can't we just have one clear, consistent answer about menopause and hormones? So today I'm tackling this head on. We're going to explore why this confusion exists and how the system is failing women and keeping them scared. Honestly, we'll discuss the lack of training for doctors, the lingering fears surrounding hormone therapy and the inconsistent interpretation of the guidelines.

Speaker 1:

By the end of this episode, I want you to feel like you have a better understanding of this complex issue and, most importantly, know how to advocate for yourself moving forward. Because here's the thing menopause is hard enough without feeling like you're navigating it blindfolded. So let's pull back the curtain and figure this out together. All right, let's start with the big question why is there so much confusion about hormones in menopause? There's no single answer, but there are a few key factors that all work together to create this perfect storm of misinformation and mixed messages.

Speaker 1:

First, let's talk about the lack of education among doctors. Many physicians, especially those trained decades ago, received little to no formal education about menopause or hormone therapy. Women's health as a specialty has historically been underfunded and underprioritized in medical training, and menopause, being a natural transition, was often overlooked entirely. And let's not forget the generational biases. For years, the approach to menopause in medical school was often about simply managing symptoms rather than understanding how to truly support women through this stage of life. I have talked about my own personal story with my general physician, who told me when I mentioned hormones to her years ago, she told me that she would rather be in jail than go on hormones. She was very misinformed. I don't talk to her about hormones anymore and I wonder if she's changed her tune, hopefully but that back then she thought that hormones were very dangerous.

Speaker 1:

We know much better now, because then there's the fallout from the 2002 Women's Health Initiative study. This was a turning point that cannot be overstated. The study linked hormone therapy to increased risks of breast cancer, heart disease and stroke, and it caused widespread panic among both patients and doctors. What was the issue? The study was deeply flawed. It used older formulations of hormones at higher doses and focused on women who were, on average, in their mid to late 60s, long past the typical onset of menopause. Modern studies have since shown that hormone therapy is generally safe and effective for most women when started within 10 years of menopause or before the age of 60. Started before the age of 60, not end at age 60. But by the time these clarifications came out, the damage was pretty much done.

Speaker 1:

The fear was embedded in this public psyche and many doctors still haven't updated their understanding of the research. And what makes this worse is that patients often trust their doctors to have the latest information, and when they don't, confusion grows. Imagine one doctor saying to you hormones are safe and beneficial, while another warns you to avoid them completely. I mean that still goes on right now. This disconnect creates a ripple effect of uncertainty and women are left wondering who do I believe?

Speaker 1:

Finally, let's talk about the misinformation on the internet. While access to health information has been empowering in so many ways, it's also a double-edged sword. Social media is full of influencers, wellness gurus and even doctors promoting conflicting messages about menopause and hormones. Some push quote-unquote natural alternatives that lack scientific evidence, while others oversimplify the science to fit their brand or product. It's no wonder women are overwhelmed. They're being pulled in every direction and it's hard to know which path is the right one. So, to sum up, the confusion and where it started. This comes from a combination of outdated doctor training, lingering fear from flawed studies and an overload of conflicting information online. It's a perfect storm and unfortunately, women are just caught right in the middle.

Speaker 1:

Now let's dig into another major factor contributing to this confusion the disconnect between medical guidelines and how they are actually applied in practice. You'd think that clear guidelines would give us clarity, but instead they often add to the confusion. Why? Because they leave room for interpretation. For example, guidelines from organizations like the Menopause Society, which was formerly called the North American Menopause Society, so you might still see it worded like that. Guidelines from the Menopause Society recommend hormone therapy for most healthy women under 60 or within 10 years of menopause. But what happens if you're 61 and you're otherwise healthy? Some doctors interpret the guidelines strictly and treat 60 as a hard cutoff. But that's not what the Menopause Society says. They say that it is up for interpretation and if you are healthy, you can stay on hormones. So then there is those other doctors who take a more nuanced approach, considering the individual patient's health and symptoms. This is so inconsistent because it leads to wildly different advice for women in similar situations, and another issue is that not all doctors keep up with the latest updates to these guidelines.

Speaker 1:

The medical field evolves rapidly, and unless a doctor is actively engaged in menopause care, they might be relying on outdated information. This can mean telling a woman to stop her hormones at 60 because that's what they learned 20 years ago, even though current guidelines say it's not necessary for many women. And then there's the influence of personal bias. Doctors are human, after all. Their own experiences, their training, even their comfort level with hormone therapy can shape these recommendations. Meaning even their comfort level with hormone therapy can shape these recommendations. Some doctors are still hesitant to prescribe hormones because they remember the panic surrounding the WHI study the Women's Health Initiative study while others are more open because they've seen the benefits firsthand. This variability creates a patchwork of care that leaves women wondering why is my doctor's advice so different from what I've heard elsewhere? And lastly, we have the issues of compounded hormones, which adds another layer of complexity and confusion.

Speaker 1:

Compounded hormones are custom-made formulations that some doctors prescribe as an alternative to FDA-approved hormone therapy. Compounded hormones are often marketed as natural or bioidentical. You have probably heard these words out in the world of women's health. But here's the problem they're not regulated in the same way as standard therapies. That means their safety, efficacy and dosing really can vary widely. They're not FDA approved, and the FDA is the gold standard for drugs and medications. Now there's also a widespread belief that compounded hormones are safer because they're marketed as natural. But in reality compounded hormones come with significant risks. Without FDA oversight, there's no guarantee of consistent dosing or purity, which can lead to unpredictable effects.

Speaker 1:

The irony here is that many FDA-approved hormones are also bioidentical, meaning they are chemically identical to the hormones your body produces. So did you hear that? I want to make sure that everyone listening hears that, because a lot of women come to me and they think bioidentical is more natural and better. But many FDA-approved hormone formulations are bioidentical, so you can feel okay taking the FDA-approved medications. These options have undergone rigorous testing and are much safer than compounded alternatives. Unfortunately, many women still don't realize this and they turn to compounded hormones, thinking they're making the safer choice, when the opposite is often true.

Speaker 1:

All right, I don't want to berate this point, but I have to say one more thing about this that the availability of bioidentical hormones through naturopaths and alternative health providers only adds another layer of confusion. While these providers often have the best intentions, sometimes they may not always follow the same evidence-based practices as mainstream medicine. This can lead to women being prescribed treatments that sound appealing but again lack the scientific backing to ensure their safety and effectiveness, lack the scientific backing to ensure their safety and effectiveness. So this disconnect between guidelines and practice leaves women totally confused again and frustrated. How can you trust the advice you're getting when it varies so much depending on who you see? And how do you know if your doctor is truly up to date or influenced by outdated studies and biases? These are the questions that so many women are grappling with, and they highlight the urgent need for better education and consistency in menopause care.

Speaker 1:

Now let's shift gears and talk about how misinformation one of my favorite subjects, and the marketing machine behind it, exploits women's fears about menopause and aging. This is one of the biggest reasons we're seeing so much confusion about hormones, and it's a problem that extends far beyond the medical field. Again, let's talk about that word natural for a minute and talk about how the word natural is used in marketing. You see it in food, you see it on food labels, you see it on medications. It's everywhere right.

Speaker 1:

Products marketed as natural or plant-based are often framed as a safer or healthier alternative than FDA-approved medications. Even when you see the word natural on food products, you think that they are healthier, but the word natural is really a meaningless term. Compounded hormones, for example, are sold as natural bioidenticals, which make them sound superior to standard hormone therapy, but, as we discussed earlier, compounded hormones are not regulated and their safety and efficacy are not supported by robust clinical evidence. The term natural is just a marketing buzzword designed to tap into our fears about synthetic or pharmaceutical products. Now the same thing happens even with supplements. Walk into any health food store or Whole Foods, or scroll through social media and you'll see countless supplements claiming to balance hormones, boost your energy, reverse aging. These claims are rarely backed by solid science, but they're incredibly appealing because they promise an easy, one-size-fits-all solution to complex problems. And, let's face it, who wouldn't want an easy fix when they're feeling overwhelmed? So I want to talk about this role of fear in all of this.

Speaker 1:

Women in midlife are often bombarded with messages that tap into their deepest insecurities our fear of aging, our fear of weight gain, our fear of just losing our vitality. These fears make us more vulnerable to buying products that promise, to quote, fix menopause, even when those products aren't proven to work. So, whether it's a supplement, a cream, a detox program, the marketing is designed to make us feel like we need it to stay healthy, beautiful and relevant, because women in their 50s and 60s going through this menopause journey can really start to feel invisible sometimes. And then let's throw in the internet, social media platforms and wellness influencers have become hotbeds of misinformation. Some of these influencers genuinely believe in what they're promoting, but others are simply capitalizing on the menopause conversation to sell products. The problem is, it's incredibly hard to tell the truth and what you are supposed to believe. So where does that leave us?

Speaker 1:

If the current state of menopause care feels like a confusing maze, what does the future hold for us? I think, thankfully, there's a reason to feel hopeful. We're almost like sifting like. It's almost like sifting flour through a colander. We're getting rid of some of the not so desirable things and we're highlighting the things that are really starting to work. And the conversation is growing. And as the conversation around menopause grows louder, we're starting to see really promising changes. I feel hopeful about this and a few shifts that could transform the way women experience this stage of life. Transform the way women experience this stage of life Now.

Speaker 1:

One of the biggest shifts happening right now is the growing emphasis on education, specialization in menopause care. So organizations like the Menopause Society and I will put a link to them in the show notes so you can go on there and they've got lots and lots of really good, credible information, but they are leading the charge by certifying healthcare providers in menopause medicine. My gynecologist, for example, is certified through the Menopause Society. That's how I found her. I went onto their website. They have a whole database of practitioners and you can find your own doctor too. This ensures doctors are equipped with knowledge that they need to guide their patients confidently and accurately. So imagine a world where every gynecologist or primary care provider has a deep understanding of menopause and doesn't shy away from discussing hormone therapy. That's where we're headed, but we're not there totally yet.

Speaker 1:

Another exciting development that I see on the rise is the beginnings of personalized medicine. Researchers are beginning to explore how a woman's genetics from medical history and lifestyle can inform more tailored approaches to menopause care. For example, we might soon see tools like genetic testing playing a role in determining who would benefit most from hormone therapy or other interventions. While this field is definitely still in its early stages, it's a glimpse of a future where care is not only more effective but also more empowering for women, and technology is definitely playing a role here. Apps and telemedicine platforms dedicated to menopause are emerging, providing women with easier access to expert care. Imagine being able to connect with a menopause specialist through a video call or track your symptoms in an app that offers personalized recommendations. This is the kind of innovation that is beginning to make menopause care more accessible, especially for women in rural areas or underserved areas or who cannot get access to good medical care.

Speaker 1:

But perhaps the most encouraging change that's happening right now that I see is on a cultural level. Menopause and taking hormones for menopause symptoms is finally starting to lose its stigma. Women are talking about it openly, sharing their experiences and demanding better care. I see this all the time. Like I said at the beginning, 10 years ago, when I was on hormone therapy, none of my friends were. No one was talking about it, and that's when I started getting really interested in this field, because not only was I going through it, but so many women were not talking about it. It was a big, deep, dark secret. But that's changing. Celebrities, authors, advocates are shining a light on menopause, making it a more mainstream topic rather than a taboo one. The more we normalize these conversations, the harder it will be for outdated practices and misinformation to persist. So, while the present might feel frustrating, the future of menopause and the future of hormones is really looking brighter. I think. I'm encouraged. I feel very positive about it.

Speaker 1:

It's just up to all of us to keep pushing for changes, to ask questions, demand evidence-based care and support organizations that are working to improve the system, and to let go of those social media influencers, supplements that promise a one-size-fits-all fix and really learn to advocate for yourself. Okay, so we've unpacked why there's so much confusion about menopause and hormones. Let's talk about what you can do to navigate it. While we can't fix the system overnight but we are trying there are concrete steps you can take to cut through the noise and advocate for yourself. The first thing you need to do is to find the right health care provider. This might mean seeking out a menopause specialist or a provider who's certified by the Menopause Society. Again, link in show notes. Don't be afraid to ask questions during your appointments. How familiar are they with the latest research on hormone therapy? Are they comfortable discussing the full range of treatment options, including even non-hormonal approaches? The right doctor will welcome these questions and not get scared off, and they'll work to create a plan tailored to your needs. They'll work to create a plan tailored to your needs.

Speaker 1:

Second, I want you to educate yourself with credible resources. In our age of total misinformation and there is a lot out there. It's critical to know where to turn for trustworthy information. Again, start with evidence-based organizations like the Menopause Society, or there's even another organization called the International Menopause Society. There's books written by respected researchers or clinicians, and that can lead to some of its own confusion. I've talked about this in other episodes, about how even some doctors can take the reins and run with it, because they know that there's business in menopause right now. So we want to be careful. When you see doctors overselling supplements and diets and stuff, just be a little wary of that. But there are a lot of good books out there that discuss menopause, and I'll actually link a few of my favorites in the show notes.

Speaker 1:

The third thing I want you to do is to just be cautious of those quick fixes and marketing hype. If a product or program claims to balance your hormones overnight or promises results that sound way too good to be true, it probably is. So look for treatments and interventions that are backed by solid science, not just anecdotal success stories. Remember, this is your health and it's worth more than falling for clever marketing. And the fourth thing I want you to consider is to advocate for transparency in your care.

Speaker 1:

If your doctor recommends a treatment, ask why. What's the evidence supporting it. What are the risks and benefits? If your doctor advocates not taking something, ask why. Where's the evidence? Where's the evidence that I have to go off of hormones at age 60? Where's the evidence that I can stay on hormones after 60? This isn't about being difficult. It's about being an active participant in your own health journey. A good provider will respect your questions and take the time to answer them thoroughly. So don't be afraid to ask for questions and to speak up and finally connect with a community.

Speaker 1:

You're listening to this podcast. That's fantastic. There's other women just You're listening to this podcast. That's fantastic. There's other women just like you.

Speaker 1:

Listening to Navigating menopause can feel isolating, but you're not alone. So you can join a support group, like my online course, nourish your Menopause Journey, which, again, I told you I'm starting in March. I'll have the link to that, too, in my show notes which, again, I told you I'm starting in March. I'll have the link to that, too, in my show notes and that provides us with a unwavering support of women who understand exactly what you are going through. In that group, we share experiences, tips and even the frustrations, and this can be credibly empowering to know and feel like you are not alone in this journey. So, at the end of the day, you, and only you, are your own best advocate. By staying informed, asking questions and pushing for the care you deserve, you're helping not only yourself, but also the women who will navigate this journey after you.

Speaker 1:

I think about my daughter, who's only in her 20s, but I want to know that by the time she's going through menopause, this is not going to be the same menopause experience. She's going to have it very easy. That's my hope. Together, we can create a future where menopause care is clear, consistent and empowering for everyone. So I hope this has been helpful for you and I really would love to hear from you.

Speaker 1:

Drop me an email and let me know about your menopause hormone experience. Are you on hormones? Are you considering taking them? How do you feel about them? Do you feel nervous about taking them? Are you still caught up in the old studies where the belief is that hormones are dangerous or not safe? Maybe you don't even have symptoms to justify them, but you're sort of hormone curious. I'd love to hear from you and about your experience. So drop me a line. All right everybody. Thank you so much for tuning in today and listening. Know that you're not alone in your menopause journey and your hormone experience, and I can't wait to see you next week. Have a great day.