141. Menopause: Hormone Therapy Is Safer Than You Think

For over 20 years, millions of menopausal women have avoided a treatment that could meaningfully improve their health — not because of solid science, but because of a study that has since been reanalyzed, reframed, and largely walked back by the medical community. If you have ever been afraid of hormone replacement therapy, this episode is for you.

In this episode of Cycle Wisdom, Dr. Monica Minjeur walks through the real story behind the Women's Health Initiative study, what its major limitations actually were, and what updated guidelines now tell us about the safety and benefits of bioidentical hormone replacement therapy. Through the story of Francine — a 52-year-old who suffered three years of hot flashes, brain fog, and sleepless nights out of fear — you will see what becomes possible when women are finally given the full picture.

You will learn:

• Why the original hormone therapy research was fundamentally flawed — and what the science actually shows today
• How bioidentical hormones differ from the synthetic hormones used in the original study — and why that distinction matters enormously
• What the real risks of untreated menopause are, including heart health, bone loss, cognitive decline, and urinary tract infections

If menopause has been stealing your quality of life, you do not have to keep suffering. Learn more or schedule a free discovery call at radiantclinic.com.

Transcript

Speaker 0:01

For over 20 years, millions of women have avoided a treatment that could change their lives based on fears that science now says may be overblown. Today we are entering a new chapter, menopause. What happens when your Period finally stops, and what if everything you thought you knew about hormone therapy was actually not true? After many episodes on fertility and cycle health, this is a new but connected chapter. Menopause is not the end of your hormone story. If you've been scared away from hormone replacement therapy during menopause, thinking it might be dangerous, then this episode is just for you. I'm Dr. Monica Minjeur, the host of Cycle Wisdom, where we help women restore hormonal balance and reclaim their wellbeing through personalized healthcare, grounded in clinical excellence. So let's get started, as always, with a story about a patient of mine that will call Francine. Now Francine came to see us at about 52 years of age, and she had been suffering for the last three years with hot flashes that woke her up in the middle of the night, as well as severe brain fog at work as an accountant. Her primary care doctor had mentioned hormone replacement therapy and she immediately said, no, due to fear of cancer. She said, I remember hearing a story that hormone replacement therapy can cause cancer, so I didn't even wanna consider it. Over the course of three years when her period stopped happening, she tried everything she could think of. She cut out caffeine. She tried multiple different over the counter supplements. She tried an earlier bedtime. She tried meditation. She saw multiple different holistic practitioners, but with minimal relief of her actual symptoms. She felt like menopause was stealing her life physically and emotionally. A friend of hers sent her to our clinic and at her very first appointment, the first question she asked me was, is hormone therapy really safe? I am terrified about my cancer risk. So we spent a lot of time going through the research explaining what actually happened with the Women's Health Initiative study. We discussed new guidelines and talked about the black box warning removal on vaginal estrogen. Francine left that appointment and told me for the first time I feel like someone actually has given me the full picture. I feel like I have options and there's actual science behind getting help that I need. After we did some initial blood work, we started her on some bioidentical hormone replacement therapy, some targeted supplements, and discussed lifestyle changes specifically to help improve her symptoms. Over the course of the next five to six weeks, she felt like her hot flashes became much more manageable. Her sleep returned within the next couple of months, and by the time we checked in again at her six month follow up, she said, I feel like my brain fog is almost completely gone, and I feel like myself again. Most importantly, she said, I can't believe that I let fear over these hormones steal three years of my life. I wish I had started sooner. So let's step back a second and look at the big picture. If you are somebody that is in menopause and is not using hormone replacement therapy, you are not alone. Approximately 80% of women will experience some level of menopausal symptoms, but fewer than 10% of all women actually use hormone therapy. And this fear has a major source, especially here in the us. Starting in the year 1991, the National Institute of Health started a project called the Women's Health Initiative, and the focus of this was to discern whether hormone replacement therapy was appropriate and helpful, and if there were any potential risks, side effects or benefits or what the really the outcomes should be as far as how guidance should move forward for medical care. Almost a full decade later. In 2002, the principle results of the Estrogen Plus Progestin trial was published in jama, which is a major medical publication, and this is the publication that triggered widespread alarm about breast cancer and cardiovascular risk in the us. And this meant that nearly half of all women dropped their hormone replacement therapy immediately. The following year in 2003, the FDA imposed black box warnings on all estrogen containing hormone therapy products. And in the year 2004, a second Women's Health Initiative paper on estrogen alone, therapy was published. The concern here is, is that the media really ran with this. Doctors became more cautious, women became terrified, and for over 20 years, this fear has kept millions of women away from treatment that could change their lives. What we know now is that the Women's Health Initiative study had major limitations. So if we break it down and look at the science currently, we know that a couple of major things played a big role in what these outcomes looked like. So for example, the average age of participants was 63. This is well past the age of menopause transition for most women, and we know now that if we start hormone therapy too late, it actually can have problematic effects. Another major limitation is that this study did not utilize bioidentical hormones, which we know now is very important. They were using conjugated equine estrogen, which means the estrogen came from horse urine. They also utilized progestin instead of progesterone. Again, not a bioidentical hormone. So when the data was reanalyzed, many of these increased risks actually disappeared altogether, or in some cases became very small. The breast cancer increased finding was actually driven partly by unusually low cancer rates in the placebo group, even lower than the national average at that time. So again, the science has really evolved in the past 20 years, and so we've had follow-up research, newer studies and updated guidelines, which all point to one key finding is that hormone replacement therapy is incredibly safe for most women. When started appropriately. We've had guidelines from the National Medi Menopause Society in 2023. We've had updates from the American College of Obstetricians and Gynecologists. The FDA removed the the black box warning on vaginal estrogen just this last year. Unfortunately though many women like Francine still didn't know this, and they were still living in fear from those headlines of the media back in the early two thousands. So let's go back and kind of talk through why this makes a difference. The Women's Health Initiative actually showed that they were using the wrong population, the wrong hormone type, and the wrong timing. And this makes a huge difference because those risks lost significance on re. What we now know is that timing makes a big difference. And in general, we say the earlier the better. So if you are in early menopause or even in perimenopause and you are having symptoms, now is the time to start treatment, not 10 years from now. We know now that starting hormone replacement therapy within five to eight years of your last period is considered safer and more effective. In fact, some studies show that if you start therapy beyond 10 years after stopping your periods for systemic estrogen, meaning the estrogen that I would take, that impacts my entire body, that's actually not recommended in most cases. We also know that not all estrogen is created equally. So even if it's we're looking at bioidentical estrogen, specifically transdermal estrogen, so whether that's a topical cream or whether that's a topical patch, it does not. Show the same increased breast cancer risk as we can see with taking just an oral estrogen pill, for example, and significantly decreased risk with bioidentical hormones versus synthetic across the board. Why bioidentical matters is that it is molecularly the exact same chemical structure that your ovaries make. Your cells recognize it, your liver metabolizes it differently, and their risk profile is incredibly different. This is why at Radiant Clinic, whether you are having cycles or if you are menopausal or if you are pregnant. We only use bioidentical hormone replacement therapy because we want to give your body something that it recognizes is designed to use and is safe for long-term utilization. The real risk here is not treating menopause, so an estrogen drop, which is what happens when you hit menopause, your estrogen levels will decrease dramatically, and they typically will stay low. We know that estrogen drop increases your risk of heart disease. Bone loss or osteoporosis, cognitive decline, or increasing your risk for dementia, genital urinary syndrome of menopause and urinary tract infections. In fact, the statistics on urinary tract infections are significant. Approximately 10% of all women who are postmenopausal will have a UTI every year. Recurrence rate jumps to 55% after menopause. So if you have had even a single urinary in tract infection during menopause, you are 50% more likely to have another one. Urinary tract infections are the most common cause of antibiotic prescriptions in older women, and if infection enters the bloodstream, which is more common in elderly women, it increases your death rate by 40 to 50%. This is incredibly important because there are ways to treat and prevent urinary tract infection. Vaginal estrogen restores urogenital tissue rebuilds good bacteria, and improves your overall tissue health to decrease your risk of urinary tract infections. This is why we and many others in our field are commonly heard to say vaginal estrogen can save lives. If we decrease the urinary tract infection rate, we are improving overall health, quality, quality of life, and decreasing your risk long-term for infection that can be deadly, especially in elderly women. Estrogen also with appropriate treatment can impact positively your heart health, brain health, bone health, sexual function, vaginal health, and longevity. So this is not just about treating hot flashes or other symptoms that you may think are annoying. The real question you need to ask is, what is my risk if I don't treat this? For most women, treatment is going to be a safer choice that is going to improve your overall health and significantly impact your quality of life for the long run. We are so excited to announce that Radiant Clinic is bringing on a menopause specialist. Samantha, who is a nurse practitioner, is going to focus entirely on helping menopausal women get the help that they need to actually improve their symptoms. And live a better, more healthy life. She's going to focus on root cause treatment. So treating the underlying causes of menopause and addressing the other symptoms we oftentimes find with menopause. So looking at things like thyroid health, insulin resistance, metabolism, hair loss, how are we dealing with libido and hot flashes, and all of these other symptoms that are very commonly seen in menopause. Treatment will focus on three different aspects, focusing on lifestyle changes. Where do we need to make adjustments with your sleep, your mental health, dietary intake exercise, and how are we making sure that these things are going to be sustainable? We'll also focus on recommending any appropriate supplements specific for your unique health needs, and importantly, any prescriptions that are going to make sense for you, including bioidentical hormone replacement therapy, thyroid medications, when appropriate, and any other thing else that is unique to your specific situation. I am really excited to get to introduce you to Samantha. Next week on the podcast. I'm going to interview her and we're going to dive into this next cycle of your life, this menopause transition. We'll talk all about what Samantha's excited to do and hear her wisdom on what is possible during this transition into menopause. Imagine if you didn't have to choose between suffering and risking your own health. Imagine having the full picture, real science, UpToDate guidelines, bioidentical options that work with your body, and most importantly, imagine reclaiming your symptoms of menopause sleep. Mental clarity, energy, sense of self, overall mental health and wellbeing, not despite menopause, but by honoring what your body needs. This is what Radiant Clinic offers, root cause care that looks at lifestyle supplements, hormones, all grounded in clinical excellence to improve your health. I can't wait to talk with you more next week where we'll talk to Samantha about how we are going to work through this. What are the symptoms to be looking for when it comes to menopause care, and what are the evidence-based steps we can take to get you on the right path to feeling more like yourself again?