153: REPLAY 21 questions about hormone therapy

This is a replay of Episode 129, originally aired on 16 November 2024.

In this solo episode, Hotflash inc podcast host and founder Ann Marie McQueen writes down all the questions she has about hormone therapy (and what we hear about hormone therapy).

This is a long time coming: she's been researching perimenopause, menopause, and women's midlife health for 5+ years now.

Settle in. And if you have any questions of your own, use that handy text message feature and send them our way.

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Transcript

[00:00:00] I'm Anne Marie McQueen, journalist and proud 50 ish woman, and we are here looking for the true truth in perimenopause, menopause, midlife, and beyond. Opening our minds to other possibilities is not always easy. Half I think. You're all woman to me. All right, Anne Marie.

[00:00:19] Ann Marie: Welcome to the Hot Flashing Podcast. It's a solo episode and today we're doing something that I love to do. I'm asking just a ton of questions. I'm just talking about things that don't make any sense to me. And I've been studying hormone therapy. I've been studying menopause, I've been studying perimenopause for five years now and casually before that, reading as much as I could about it.

[00:00:42] So I have a lot of things that I don't understand and this is just like the beginning of it, but this is just me sitting down and thinking of all the things that I could write down that make no sense to me. So first of all, I think about the entirety of perimenopause. That's why I [00:01:00] basically launched this platform out of nothing and spend all my time doing it because I think it's such a full, rich transition, such a pain in your ass for so many reasons.

[00:01:11] And I had such a hard time. I had such a hard time. I had such a hard time. So that's what like fuels me forward, even though I've gone through menopause and I'm doing pretty good. And I, it turns out I have lots of other things wrong. But listen, one of the things I think about all the time is hormone therapy.

[00:01:33] So I, I think about how much it helps women. I think about how some women don't need it. Other people need it, take it. Other people need it, but can't get it. And then all sorts of people are telling us like, you have to take it or you won't be able to be functional on the other side of menopause. And that's just the start of my questions.

[00:01:55] That's just the beginning. I think about when you search menopause and [00:02:00] hormone therapy on PubMed, which is the National Library of Medicine database, you get 5740 results. I'm typing as I'm writing this, like how much of a multitasker. Anyway, and when you do the same for perimenopause, you only get 470 studies.

[00:02:16] Like what? Dr. Susan Davis from Monash University, who's a hormone therapy expert said on this podcast, we have barely any studies on perimenopause and boy, was she right. So that means people are extrapolating from menopause studies of which there aren't very many and applying them to perimenopause.

[00:02:37] And they are very different things. When you go through menopause, you're at a much lower level of hormones all around, your progesterone's gone, you're producing estrogen from your adrenal glands, hopefully, and your adipose tissue. And during perimenopause, you're still flowing with your estrogen, high, low, high, low.

[00:02:57] Your progesterone is falling, your testosterone [00:03:00] has fallen. It's just very different scenarios, right? And I can attest that perimenopause was like a nightmare rollercoaster. And I've went through menopause, a year and a couple of months ago. And I can really feel myself, Evening out. And so there's not the same thing.

[00:03:16] Menopause is after you've gone a year without your period and you're not fertile anymore. And perimenopause is all the years before it, when you're in like a PMS y puberty stage. But, the other end of it. In the grand scheme of things, we don't have enough research about it.

[00:03:32] And, I just found out that there's way more research on cows and hormones than women in hormones. There are more than 35, 000 studies on hormones in cows for, milk production and all the rest of it. So that just shows you that's a really big business. We're big business too. I guess people are going to figure that out.

[00:03:53] More about hormones in cows than they do in us. That's the bottom line. So anyway, this is a dearth of information, [00:04:00] and it's what's got me scratching my head all the time, and the things I hear online, reading the media, and hear right here on my podcast, from doctors and people I respect as experts, but everyone has gaps in their knowledge.

[00:04:10] Here they are. I've numbered them, but they're in no particular order, except number one is the biggest head scratcher to me. Number one is how many doctors don't really seem to understand the difference between progesterone and progestin. This slays me. This is something that the, there's almost like the right and left when it comes to menopause treatment, because you have mainstream menopause treatment.

[00:04:33] And you have naturopathic doctors, integrative, functional, I say, whatever they're on the right. I'm waving my right hand. So the forward thinkers recognize that we lose our progesterone first and many of the symptoms of perimenopause actually might be helped with progesterone and adding estrogen during this time is not great.

[00:04:55] And this brings me to point two, the menopause industrial complex has an estrogen [00:05:00] first estrogen always approach. And this cadre of forward thinking practitioners over here, I don't know, on the right is successfully treating women in perimenopause and menopause with a progesterone first approach, which is based on the premise that progesterone falls first and estrogen rises and falls over time as it slowly falls.

[00:05:21] You might be having symptoms because you have high estrogen with low progesterone. And a lot of doctors will confidently tell you that you need estrogen for that. And a lot of other doctors will say, That's crazy, why would you add more estrogen to high estrogen? High estrogen is causing the problems.

[00:05:42] But on the mainstream, there's not even really any recognition at all that this is even the case. It's incredibly odd. Number three, there are doctors who refuse to acknowledge that estrogen could be dominant or that there is even anything called estrogen dominance. And they're learning about it more [00:06:00] and you're seeing more doctors on, in the mainstream talk about high estrogen, but certainly don't call it estrogen dominant.

[00:06:07] For some reason, that term is verboten and I can only guess why it feels like messaging coming from somewhere. It just seems like messaging. Dr. Jen Gunter wrote a whole. Piece about it, about high estrogen. Number four, there are doctors who will happily tout the benefits of estrogen only therapy. Even though the only women who can take estrogen only hormone therapy have had their uteruses removed or have had full hysterectomies.

[00:06:38] So they don't need progesterone to offset growth in their uterine lining. But what you're doing is talking about estrogen only therapy that only some women can use And extrapolating those benefits that have been found in scientific research to all women. And it's not fair because I can't take estrogen only therapy.[00:07:00]

[00:07:01] And then we have point number five, that any doctor would even talk about the benefits of estrogen only therapy when progesterone and testosterone are equally important hormones. So doesn't that just show you the estrogen obsession? Progesterone and testosterone are nothing because people are happy to tell you how great the results are in the scientific literature from estrogen only therapy, which is just, it's also strange to me.

[00:07:28] And then number six is

[00:07:30] that any doctor would speak confidently repeatedly about the awesome benefits found in the scientific literature from estrogen only therapy without stopping to ask themselves, why would we give women only estrogen after a hysterectomy? Okay. After all, they walk into the hospital with all their hormones intact.

[00:07:47] Yeti Stereo Microphone: Why did they only need one rep replenished or replaced? And I'm talking about women who have hysterectomies or partial hysterectomies well before menopause. The [00:08:00] guidance is that they really should take hormone therapy up until at least the age of menopause, because the outcomes when you lose all your hormones early and all at once are not great.

[00:08:12] across the board. It's always worth pointing out. Okay, number seven, that doctors would talk about estrogen only therapy without acknowledging the very real increase in associated risk for ovarian cancer for women who are on it. which seems to be offset by the addition of progesterone.

[00:08:30] So just let me repeat that there is an increased associated risk for ovarian cancer when women are on estrogen only therapy. So women have a partial hysterectomy for some reason they're given estrogen only therapy, duh, it's 2024, but this has been happening for years. And then there's an, a greater risk for ovarian cancer.

[00:08:56] Cancer. They've got their ovaries and [00:09:00] this is demonstrated in the literature and I never hear anyone talking about it or acknowledging it anywhere. I could miss it. It's not like I, on duty 24 seven, but I'm just saying I have yet to ever, I was blown away when I learned that a couple of months ago and looked at the body of research.

[00:09:18] It's very compelling. Number eight, that it has been. 20 years since the intrinsic patch was rejected by the FDA and the intrinsic patch was a testosterone patch for women. And there's been nothing new offered since then. That was it. This leaves women in most of the world, most of the world using off label preparations designed for men when they take testosterone or compounded varieties.

[00:09:49] And that means they have to pay out of pocket for it. Number nine, that there are only one tenth of the studies on menopause under a hundred thousand that there [00:10:00] are in pregnancy, 1. 1 million, Dr. Mary Claire Haver pointed that out on social media a long time ago and I think it's great and I quote it all the time.

[00:10:09] Number 10, that there are less than 10, 000 studies on perimenopause, meaning most of what experts say is being. extrapolated from menopause studies, and I already pointed that out, but I think it deserves to a number on the list. Nonetheless, number 11 that I'm hearing about doctors prescribing progesterone cream to offset estrogen.

[00:10:29] Although it's not at all recommended by guiding bodies like the menopause society of North America. When you take estrogen and you have a uterus, you need to take a corresponding amount of progesterone to prevent the thickening of your uterine lining leading to a condition called endometrial hyperplasia, which can lead to cancer.

[00:10:56] And This is like one of the first [00:11:00] things I learned as a journalist covering this. But I had a doctor on the podcast who was pitched to me by a hormone therapy company and she said that's what they prescribe and they've never had a problem. And I was open minded and I was like, huh, but then the more I've learned about it, I just did not feel comfortable.

[00:11:16] So I never ran it. And recently one of my best friends has had prolonged post menopausal bleeding, very worrisome when her ding dong. doctor prescribed it for her because oral micronized progesterone was drying her eyes out. And so she was being prescribed this progesterone cream and she's just found a new great doctor.

[00:11:36] And the doctor was like, what? We don't do that. No one does that. So it's 2024. Let's get this together. If someone hears this and they're doing it and they have a compelling reason, like I'd always love to know, but it seems for most of my research that this is not a safe thing to do. Number 12, that people use terms like debunked to describe the entire Women's Health Initiative study [00:12:00] because of some problems that came out in 2002.

[00:12:04] And basically this was a huge study and it's been a treasure trove of data. And if I hear someone say the Women's Health Initiative study was debunked, I usually think they're a dum. Number 13. That one of the reasons people say the Women Health Initiative findings on breast cancer and heart disease, these were the findings that said there were risks and this is what scared all the doctors and got all the people off hormone therapy and now it's under 5 percent and blah, blah, blah, the researchers used relative risk calculations to describe the increase.

[00:12:38] Rather than absolute risk calculation. Now I'm gonna go into this in a future newsletter. It's very complicated, but essentially, relative risk calculations are much higher, and usually they're used if it's in a drug trial when the, [00:13:00] researchers want to present like the findings. They seem really good.

[00:13:02] So it's oh, it reduced your risk of getting this disease by 73%, when in reality if you had a hundred people who were on the drug and a hundred people who weren't, it might be like one extra person. Who didn't get the disease. Does that make sense? It's a scientific slate of hand and it's confusing, but once you see it, you can't unsee it.

[00:13:23] And it's very well known in the scientific community that absolute risk reduction is the one you look at to get a real sense and that relative risk reduction can really inflate what you're trying to say. But so it's fine when the women's health initiative, Oh, they used relative risk calculations and it made it seem like.

[00:13:46] The risk was overblown, but whenever I see hormone therapy studies now and doctors are standing against green screens and they're saying there was a 73 percent reduction in the risk of whatever, they're very [00:14:00] happy to use relative risk reduction.

[00:14:03] But no one would be excited about absolute risk reduction and

[00:14:05] you probably wouldn't take very many medications if you used it. Number 14, that so many people walk around saying that hormone therapy prevents dementia, cancer, and heart disease based on observational studies, often using the afore mentioned. relative risk reduction when guiding bodies don't recommend it and the various specialties don't either.

[00:14:25] And if anyone ever offers some stronger evidence, the people confidently saying hormone therapy prevents these things, ignore it. And the media does too. For example, this summer, the Lancet commission on dementia looked at hormone therapy for prevention of dementia for the first time, and they did not recommend it.

[00:14:46] And in 2023, the American college of cardiology The Cardiovascular Disease in Women Committee, that is a mouthful, published a meta analysis on the subject and it doesn't recommend hormone therapy to prevent [00:15:00] heart disease. And there was barely any coverage of either. Number 15. I hope you're hanging in with me.

[00:15:07] That scientific studies and meta analysis like these I just mentioned are being conducted today, making their conclusions without separating synthetic and bioidentical hormones. We are having a lot of signals that progestins are the problem. Synthetic progesterone. If there is risks for dementia, if there are risks for breast cancer, then it lies in the progesterone.

[00:15:34] Synthetic progesterone, a. k. a. progestogens. And I read study after study after study, and I'm like, ooh, did they? No. They just lump it all in together. This is insane. It's like, why even bother? That's how I feel, if anyone cares. Number 16, that no one seems to care about conflict of interest anymore.

[00:15:56] When you say, you talk about something in a positive way because you could gain [00:16:00] financially from it. So many people who promote hormone therapy stand to benefit from it financially, either directly or indirectly. I just don't know why you think you're going to get very well rounded information.

[00:16:13] from people who stand to benefit financially from giving it. I'm not saying you shouldn't listen to them. I'm saying you should listen to a bunch of people. Some people who won't benefit financially from the information they're providing is all I'm saying. Like I'll tell you about hormone therapy.

[00:16:29] I'm not going to profit from selling hormone therapy. So maybe I'm someone when you want to listen to, or some other educator. Number 17, that the standard hormone therapy regime presented by the menopause industrial complex is so simplistic.

[00:16:46] Recent findings sent to the menopause society of North America found that hormone therapy uptake was very low under 5 percent and it's dropped dramatically since the women's health initiative study. But they [00:17:00] only look at estrogen containing hormone therapy. And gosh, people are on all sorts of hormone therapy, progesterone, DHEA, pregnenolone, testosterone.

[00:17:14] These are hormones. This is hormone therapy. And, forward thinking people are, mixing an estriol with estradiol and that kind of thing. There are just so many ways to prescribe this now. And yes, you probably want hormones that are approved by the FDA or the FDA equivalent, just if they're compounded, the individual batches aren't because they never could.

[00:17:42] That is usually up to say in the U. S. it's up to the state to oversee that. Number 18. On the we are a commodity front. Why no one seems to grasp that we are a commodity and that there's a huge commercial push to get us back on hormone therapy [00:18:00] and keep us taking it for the rest of our lives.

[00:18:03] And I don't understand why pointing this out makes people uncomfortable. Global Market Insights is forecasting that the hormone therapy market is set to hit US 40 billion by 2031. It's growing at like 5 or 6 percent per year. This is big business. That brings a whole bunch of things into it.

[00:18:24] And yet, when I have conversations about this or I point this out, people just get so bajiggity. They don't like it. No one likes to think that they're a product. I think that you can take something and also know that there, someone somewhere is gaining from it. And that's okay, but just Acknowledge it.

[00:18:45] Okay. Number 19 is a big one that no one can say for sure what the risk of breast and other forms of cancer is from hormone therapy, but it's somewhere between nothing and not nothing. That's how I feel to get my drift. Just check out the [00:19:00] Australasian menopause society, trying to boil this down. It's like Chinese freaking checkers.

[00:19:09] It's so confusing, like you'd have to be, I don't know what you'd have to be to understand what they're talking about. It's very hard to determine what the risks are. I know what the people who are very bullish on hormone therapy say, they'll say it's barely anything.

[00:19:25] And the people who are a little bit more cautious, One number I saw was one in 50 and that's quoted on the Australasian website. One in 50 women will go on to develop breast cancer who went on hormone therapy. Mostly if you go on it in the window of opportunity, within 10 years closest to menopause, that's the guidance, but it's still so confusing.

[00:19:49] Like last night on Tik TOK, I heard a doctor I like. And naturopathic doctors say, estrogen does not cause cancer. It can grow it, but it doesn't cause it. [00:20:00] And I'm just like, it can grow it? What do you mean? You can't say that in a TikTok video and then just move on. It wasn't even the whole subject of the video.

[00:20:08] And no one in the mainstream knows anything about detoxification pathways and estrogen metabolization. And these are real. There's something I've got to get into another day, but there is a way to. Metabolize your estrogen that is good, and there's a way that's not as good, and one involves you, excreting it, and another involves it recirculating in your body, and certainly, you don't want that, you really don't want that. You want it being made and then going out. And, I personally know of two people who have developed breast cancer within a year of going on estrogen containing hormone therapy, and one of the things their doctors said, it's not hormone therapy, but you do need to go off hormone therapy.

[00:20:48] And to the average woman, that's just like freaking very confusing. And, just as a PS here, I see doctors downplaying the risk of hormone therapy, I think to, be like, hey, don't worry about it, go on [00:21:00] hormone therapy. They're downplaying the risk of breast cancer. I see doctors doing this lately all the time and I think it's really unfair.

[00:21:06] We've grown up being scared of breast cancer and having it drilled into our heads. And now to be told like you're silly cause you're worried about it, like it will turn your life upside down. And if you take chemo and you have radiation, there are all sorts of effects from that.

[00:21:17] It is not anything anyone should be downplaying, even if it's much more survivable than it's ever been. Number 20. That some people love hormone pellets. These are little things they put in under your skin and they stay there for months. You can't get them out. And some people love them and swear by them, including 80s supermodel Kim Alexis from America.

[00:21:39] She was on the podcast and said she loved them and they helped her, doctors practiced in them say they work, say most people who are opponents don't understand how they work. They don't understand how to test for testosterone. Dr. Angela DeRosa on this podcast. It's excellent. Go back and listen to her podcast if you want to learn more about this.

[00:21:56] She's supposed to be coming back on and then there's all the people that just call them the [00:22:00] work of the devil. There's many people who think pellets are the work of the devil. I think the problem is that they're probably offered by people who don't know what they're doing and there's a lot, awful lot of people who don't know what they're doing.

[00:22:10] And I agree, I would not want some pellets put in my body by somebody who didn't know what they were doing and that I wouldn't be able to get out. That would be just, that's a nightmare, but they work for a lot of people.

[00:22:19] And number 21,

[00:22:22] I have seen multiple doctors on social media say compounded hormones are a scam. Compounded hormones are made, in a pharmacy by a compounding pharmacist. And they're just bespoke preparations of hormones because some people can't take the commercially produced forms of hormone therapy because they have.

[00:22:44] Incipients, which are ingredients that like, they can be toxic for some people. So they're not a scam. Yes, take the commercially available, probably cheaper version, but [00:23:00] compounded hormones fill a very big need. And so I've literally seen these big Dr. Menopause gurus talking about, say compounded hormones are a scam.

[00:23:11] I've seen multiple of them say the exact same thing. And then there was a trend, where everyone was putting on their hormone therapy. It was like a song and everyone was like putting their patch on and taking their little white pill and then they were taking their testosterone and they were these little clicky tubes that you get of compounding hormones.

[00:23:31] And I was like. I heard you say compounded hormones were a scam, and now you're holding up your little tube of compounding hormones. What is going on? Anyway, I'd like to know what makes you scratch your head. Thank you for listening all the way to the end.

[00:23:45] I'm going to dive into each one of these topics over the coming months in depth. methodically and I'm going to do that over on my sub stack. That is at hotflashink. substack. com. That is my [00:24:00] newsletter. That is my platform where I produce my research and there is a free version and there is a hot flashing pro paid version where you get a lot of extras.

[00:24:10] And I would love to see you over there. It's quite a community. I am. So far as I know, the only journalist that is looking at menopause in this way and perimenopause and has devoted this much time and has, become this much of an obsessive about it. Lots of people are writing about this transition and midlife, but I don't know that anyone's doing it in the way that I am.

[00:24:32] And I find that very strange. Thank you for listening to the Hot Flash Ink Podcast. And never forget, no matter where you are in your midlife transition, this is going somewhere good.

[00:24:47] Hot Flash Inc. was created and is hosted by Anne Marie McQueen, produced and edited by Sonia Mack. The information contained in this podcast is intended for informational purposes only and is not intended for the purpose of diagnosing, treating, [00:25:00] curing, or preventing any disease. Before using any products referenced on the podcast, consult with your health care provider, read all labels, and heed all directions and cautions that accompany the products.

[00:25:09] Information podcast should not be used in place of a consultation or advice from a health care provider. If you suspect you have a medical problem, i. e. menopause or anything else, or any healthcare questions, please promptly see your healthcare provider. This podcast, including Anne Marie McQueen and any producers or editors, disclaim any responsibility from any possible adverse effects from the use of any information contained herein.

[00:25:30] Opinions of guests on this podcast are their own, and the podcast does not endorse or accept responsibility for statements made by guests. This podcast does not make any representations or warranties about a guest's qualifications or credibility. This podcast may contain paid endorsements and advertisements for products or services.

[00:25:46] Individuals on this podcast may have direct or indirect financial interest in products or services referred to herein. This podcast is owned by Hot Flash Inc [00:26:00] Media.