History of Female Hormone Replacement

What if the study that scared an entire generation of women away from hormone replacement therapy was fundamentally flawed — and the fallout lasted twenty years?

Rick and Greg sit down with Caitlin Robinson, NP, to trace the full arc of female HRT: from the optimism of the 1960s through the 2002 Women's Health Initiative study that brought it to a hard stop, to the slow, ongoing rehabilitation of the science.

Caitlin breaks down the three core problems with the WHI — wrong patients (mostly women over 60, a decade past menopause), wrong medications (synthetic hormones instead of bioidenticals), and a misreading of risk that got amplified by media coverage into something close to panic. She explains what bioidentical hormones actually are, why women's hormonal balance is more complex than a single testosterone number, and what the current consensus looks like for timing, candidacy, and individualized care.

They also get honest about the downstream cost: women who lost years of quality of life, a generation of older women with fragile bones and metabolic disease, and primary care providers still practicing off guidelines written in the shadow of a flawed study.

This is Part 1 of a multi-episode series on women's hormonal health.

For informational purposes only — not medical advice. Talk to your provider.

Transcript

SPEAKER_02 0:24

Welcome back. Hey guys. Good to see you, Greg. Good to see you. Uh we're here at Healthier Ever After. Uh, and I think we're excited tonight. We're gonna actually do a multiple episode with a lot to talk about. And and I don't think we're gonna get this done. We don't want to have, you know, put out a four-hour episode. But we've got a lot of things to talk about. Uh we're gonna we've been talking the last couple of times, we've been talking about uh male hormones, testosterone, and um and what we're gonna move to today is is women's health and uh some issues with estrogen and things. Um again, we reiterated this before, but this is makes it it's even more important to remember that um the things we're discussing uh tonight and for the next couple weeks uh is is really important that you uh discuss things with your primary care or personal medical provider. Um this is for informational and educational purposes. Um we are medical providers, but we are not your medical provider, and and it's it's extremely important that you um kind of have that relationship and and and ask questions and and you know talk to your provider before starting any uh program, particularly if it involves hormone replacement or anything like that.

SPEAKER_03 1:32

It's not definitely something you don't want to be uh willy-nilly with on this one. There's a lot of information online and and and frankly, a lot of good information and and a lot of uh bad information. And really it's a lot of times it's more the context, right? Just like if you don't have context with what you're doing or what you're treating, then it definitely should be something you are discussing with your medical provider.

SPEAKER_02 1:53

And and now we're gonna we we're we've tried our technology again. We've got another guest for these episodes. Yeah. Uh bring her on. This is Caitlin, Caitlin Robison. And she is um, so she's a nurse practitioner. Uh we we've worked with her for years in the emergency department. But Caitlin, you've been like you've been around uh, you were like a wilderness firefighter and the weird stuff, and then a nurse, and now you're a nurse practitioner. Um really the I think the reason we invited you here because we both know you and know how passionate you are about um kind of these topics that we're talking about, women's health and and hormones and and things like that. That's correct.

SPEAKER_00 2:33

Yep, I agree.

SPEAKER_03 2:35

Not to mention who wants to listen to me, a couple of guys talking about two males that you're uh going on about uh female homeowns. So yeah, we've both worked with Caitlin and and Caitlin's a provider that I work with actually at my clinic, and and yeah, it just every single time uh someone meets with her, you know, we just hear so many great things. So we thought rather than keeping her hidden away in some office, that we'd uh you know put her out here and and uh ask her some questions and get some insight from her uh perspective on on all kinds of different things in regards to the history and yeah and and how hormone replacement kind of is where it's at today.

SPEAKER_02 3:14

Yeah, no, and it's it's it's a thing. Uh and it, you know, it's it's it's interesting because we've this is one of the things that I think we've seen a major shift uh in the last few years from what we've done. You know, what I so what we wanted to talk about tonight really is kind of the history of of uh female hormone replacement. And this all started back uh in the 1960s. Um Dr. Robert Wilson's 1966 book called Uh Feminine Forever. Um talked about hormone deficiency as a disease, and and throughout the 1970s and 80s, estrogen prescriptions climbed, and and uh you know, steadily women and their doctors embraced the idea that hormones could ease symptoms and uh protect bones and possibly the heart. And and so this was kind of uh what was happening. I was in the medical field, and then and then happened in 2002 the women's health initiative study.

SPEAKER_00 4:12

Right. Yeah.

SPEAKER_02 4:13

You want to comment on that?

SPEAKER_00 4:16

I do. I got me some good comments on that. I think the thing to the important thing to know about the women's health initiative was it was set up to be this big, gorgeous research project that proved that women should be on estrogen. So it was really coming from a good place in society. Medical, medical community was like, hey, let's have one gorgeous research project that locked it down that we should be getting estrogen replacement and progesterone replacement. And, you know, it was great. It's it's a great concept. And they just set it up, got rolling with it, and then went rut row. We did not do well with this. And they didn't, you know, and then it took 20 years to dig out all the different problems that came with that big project. So I think number one, they were trying to help women out, they were really trying to look at it as preventative health, and they were trying to do us a favor. It just the way it was set up was not.

SPEAKER_02 5:10

Yeah, if I recall correctly, that this was 2002, and and this the study wasn't really necessarily bad, but it was set up in a way that that made it not generalizable to um really perimenopausal women. They they were they studied other women, the the the population was was different, and and I think it's it was more of an issue of how it was reported, what the media said about this. Um yeah. You know, essentially the message was if you replace your hormones, you're gonna die of breast cancer and heart disease. Right. Like it was that almost like that, Frank.

SPEAKER_00 5:50

Yeah, that's what they were saying really quickly into the into the research um project was about nine months into it, they were starting to already see, like, whoa, we're seeing some crazy cancer rates. So they canceled the whole thing a lot earlier and then reported the results. But the biggest issue is they they had some three biggest issues. They picked the wrong meds, they didn't choose bioidentical, and we did have bioidentical medications back then. They picked the wrong study patients, and back then they were really focused on women who have been one year without a menstrual cycle or a period, which deems you in menopause. So they really wanted that hard line, which is fair. You kind of have to have some rules to a good research project. And then they underestimated that the illness trends be in a woman's life from 40 to 60 years. That's a huge shift in a time frame for a woman. And a lot of chronic illness builds infestors and builds infestors, and then boom, after 60, that's when we see a lot of these big issues. So those are my big three things that you know, and most clinicians will say those are the big, big things.

SPEAKER_02 6:57

So we're talking this study, this study um was reported as having you know some some good evidence that says, hey, this is really bad, but but it was looking at women who had already been through that whole 20-year process, not what to do during or before or around that time. Just we're looking at women after all this has already happened, and and that made it a little bit difficult to apply to kind of right that that the younger all the women in that 20-year period where you're going through menopause or you're pre-menopausal.

SPEAKER_00 7:32

Right. And they were choosing women, and many most vast majority of the ages of these women were over 60 years. So, you know, relatively speaking, they were about 10 years post-menopause, so it's after the 10-year mark. And a lot of them had never had hormone replacement at any point in their life. So from 40 to 60 when their estrogen is declining till 60, you know, and then they hit menopause, say 50, just for round numbers, and then to 60, they they might have had little breast nodes that were a little festery, you know, that might have turned into cancer. They might have had some endometrial stuff turned into cancer. They might have already had cardiovascular illness and plaque laying down in their arteries and their heart. And then boom, we throw them into this trial after 60, and we throw them into estrogen and wake their cells back up and say, Hey, do your best. And then they're like, Whoa, we're already behind.

SPEAKER_01 8:23

Yeah.

SPEAKER_00 8:24

Yeah. Like you're you just woke up beasts that were sleeping. And so, really, like, and and when the vast majority of these women were over 60, hadn't had any any hormonal replacement, they're, you know, post-menopause for years to give them hormones and wake their bodies back up, you know, wake them up out of a sleeping beast kind of per se. And then of course, your your study is gonna say, hey, you're causing cancer, you're causing cardiovascular disease, you're causing, you know, endometrial cancer, all these things. Well, it probably would have already been happened. It was already kind of sitting there. So we just don't know. But it's frustrating because that one study, you know, they're they picked the wrong patients.

SPEAKER_02 9:03

They didn't, yeah, you know, they didn't really pick these. Like almost overnight, estrogen prescriptions just stopped.

SPEAKER_00 9:14

Yeah, preventative health care for women took an absolute face in the brick wall. I mean, it just shut things down. I've even heard stories of women who were on hormone replacement, very good, low doses, safe doses. They were tolerating it very well. And then when this woman's health study came out in 2002, their doctors literally called them at home and said, Hey, stop taking that medication. I'm canceling your prescription. Like overnight, it wasn't like finishers. No, it was it was hard stop. And these women were thrown. Now, these, you know, these are these medications are keeping their symptoms at bay, tall, you know, managing their symptoms really well. Overnight, these women are going from feeling pretty good, relationship stable, they feel good mentally, to hot flashes sleeping terribly. I mean, it was right in the menopause. It was not gentle, and it was pretty cruel, pretty aggressive.

SPEAKER_03 10:03

So it jumps out to me, Caitlin, that that um that I think because me and you have talked about this study before and how frustrating it is to watch back in time. You know, it's easy to you know look back in time now and see how bad it was, but it it uh is that it was it was what 40 years of growing evidence that this is a good thing and that it's great for management of symptoms, and we're not really having any issues. And it takes one nine-month study that we all agree now and look at that there was probably um correlation, but no causation, wrong study, um, you know, participants, and so the lines in the sand that were drawn for this study were just the wrong lines. And instead of actually saying, hey, let's do something different, let's do another study, let's look at 40 years of anecdotal evidence with some studies as well. Yeah, um, we're gonna throw all that out um for one study. Yeah, and we did that for two decades.

SPEAKER_00 11:03

Yeah. And it's taken, well, it's taken two decades to dig out all what were the problems with this study. And um, don't get me wrong, you know, even bad research is good information to some extent. So we did learn some things. Hey, if there's a women, woman who's been at, you know, menopausal, so hasn't had a period for one year for at least 10 years, it's probably not safe to start hormone replacement. That's a good okay, it's a good guideline. So we've gotten some of those things. We've also gotten, hey, if you've got abnormal uterine bleeding, so like your bleeding vagin, we don't know why, your postmenopause, that's a good thing to check out. If you've had any breast nodes, if you haven't had a mammogram recently. So there's a lot of things because we're looking for those little things that maybe have hung in there, festered, because if we wake your body back up, we don't know the damage we could do. So, so even bad research does give us some information. We know which meds to use, we know not to use um provera, which is um, or sorry, premarin, which is the estrogen that's derived from horses. Yeah, I know I was gonna ask about that.

SPEAKER_02 12:09

You mentioned you talked about like what they had used in this study, and yeah, if I remember it's madroxy progesterone acetate combined with um conjugated equine estrogen. That's that's horse estrogen, right?

SPEAKER_00 12:21

It's horse estrogen. And so I don't know, and that's the thing. We did have bioidenticals available back in you know the early 2000s.

SPEAKER_02 12:28

When you say a bioidentical, help us help our audience understand what you mean.

SPEAKER_00 12:31

Estradiol and microdyse progesterone. So those are like chemical names, the madroxy progesterone, acetate. Those are all compounds. Those are all that's a synthetic progestin. And then estradiol is the most bioidentical. So when I say bioidentical, the most similar to what my body makes, yeah, I want my external hormones, the pills that go in me to resemble that the most because I want my I think it's an important note, just as a side note to remind us that's what we're talking about. Right. And and it's the you know, when you use synthetic hormones and things and force hormone or hormones from other animals, for example, that's not necessarily the closest to what I make. And so my body's not gonna know what to do with it. My cells are gonna say, hey, your key, for example, the hormone is not gonna unlock this lock, it's not gonna work on my cells. And so I think that's pretty important. And we did have those back then. They chose to use those medications because I don't, I'm not, I'm not sure. This is all speculation if it's because they were cheaper, they knew it was a big cohort, a big population of people that were they were using. I I'm not quite sure why. But you know, when it, when they all these little things combined, we now know, hey, don't use synthetic hormones if you're doing hormone replacement. Birth control is a different option, that's a whole different topic. But when we're doing hormone replacement and we're just doing these tiny doses to keep women, women's hormones stable, bone safety, you know, symptoms at bay, we don't the best thing to use is the most bioidentical hormone form. So that's another thing we learned from it. So we're gonna go. Okay, so we learned that.

SPEAKER_02 14:14

And then um, you know, we talked about the the women in the study were on average 10 years beyond menopause. Yeah, at least it seems like that's one of the other things that we we learned, or we've learned, I guess, in subsequent research is there actually is a good time to to start this. That you know, women in their 40s and early 50s actually do get benefit um oh yes, and in all kinds of things. And and women in who start this in their 60s probably don't. Uh, but this that was kind of a distinction that we were missing.

SPEAKER_00 14:47

Yep. And it's all individualized, right? I mean, like no no woman is cookie cutter. Yeah, we might resemble menstrually like what our mothers do or something, but every woman's different. It should be patient-centered. We should be talking to every woman and weighing risk and benefits, right? So, you know, even five years ago when I was first learning about hormone replacement, they were saying, you know, around menopause, if we suspect menopause. And in the last two years, we've heard, hey, if we're noticing symptoms in perimenopause, that means our hormones dipping down below a threshold that they're feeling problems. Love labs might not reflect that because things are a little wonky in perimenopause. But if we start treating symptoms in perimenopause, it's it's we're going to have the max benefit later on. And plus, we're gonna prevent a lot of these chronic illnesses from forming later on. We're gonna prevent muscle loss, we're gonna prevent mental illness exacerbations, things like that. We're gonna preserve relationships and, you know, and just keep feeling more in control of our lives, our bodies, things like that, prevent cardiovascular disease and metabolic disease like diabetes and stuff, too. So, really, yeah, now just in the last two years, they've said, hey, go ahead and start treating imperimenopause, even if the labs aren't smoking gun, hey, something's wrong here. We the hormone replacement doses are a third of what we make naturally. So, really, it's like not even birth control doses are up here. It's a three times what we make naturally. Hormone replacement is just raising our threshold so we're not dipping down into it nearly as much, which I think is an important distinction that not everybody understands, you know.

SPEAKER_03 16:27

So I think the thing that you remind me about when I'm managing uh a male's hormones is that we all we have to remember that um unfortunately we don't have a baseline from when someone's 20.

unknown 16:39

Right. Right.

SPEAKER_03 16:40

You know, like if we had a baseline on them and knew kind of where and had even like a year's time where we did three different draws, and you had a real good idea of in your kind of like prime of your life, essentially, those prime uh really mating years, um, years uh when women are uh you know, hopefully in the in the prime physical feeling great way that they feel. Like it would be so interesting for me to like uh to see what these people are at. Because I know that some guys probably never are higher than 600. So you get their testosterone up a little bit and they feel amazing. You have other guys that don't really start feeling the benefits until they're 800, 900, 1000. And it's so, I mean, if we were all the same, same with we're talking about women, I mean, yeah, it would just all be automatic. We'd get to this number, this one number, right? And that's where we'd feel good. But it's just we'd be like, boom. Unfortunately, it's just that's not how our bodies work and genetics and all these other things that uh play into it. But it's uh it's it would be so fascinating to me if we could start getting. I maybe maybe I'll have this dream later on.

SPEAKER_02 17:44

But what was your what was your level 20 years ago?

SPEAKER_03 17:46

Yes, what was your level at 20 years? Who are you at?

SPEAKER_00 17:48

And then we had that as a basic five before before you had children and you're like you're stressed and you have bills to pay. Well, the hard thing is too with women is we are not blessed to have one hormone called testosterone that just locks in and we write it like when he wants sunset.

SPEAKER_02 18:05

What's what's up with that?

SPEAKER_00 18:07

I I don't know, because it's a lot some days, I tell you what.

SPEAKER_02 18:10

But that's gonna get into that, I think, on later on. I mean, testosterone is actually women need it too. Yeah.

SPEAKER_00 18:19

Oh, oh yeah. We will talk about that. Yeah. But I think overall the thing to really remember with women is, you know, if you look at a graph, and I I'll flip a paper over and draw this out for patients. If you look at a graph of zero day zero to day 30 on a woman's cycle within a month, we're gonna be, you know, going up on one hormone and declining in another, and then they're really reactive to each other when one dips, it triggers the other one to rise and all sorts of things. So we're we have a very fluid hormonal concept where my progesterone and estrogen at days, whatever X, Y, Z would not match another woman. That's why there's a million forms of birth control because there's women who love to live higher on progesterone and lower on estrogen. We all have a body preference that is so hard to match. And that's one of the beautiful messes of hormone replacement is that it's very symptomatic. You can't have a provider that's like, it's a beautiful mess. It's a beautiful mess. It's a beautiful mess. You can't have a provider say, like, well, what? Your number is 50, and that's right in the middle of this range. What do you want from me? You have to have a provider that says, Okay, tell me what your symptom is. Let's see if we can fine-tune you a little bit. Let's raise you up here and drop this a little and work with you. It's not an overnight situation, but usually once we can get a woman dialed in, especially once they're in menopause and they're not making their own, you know, hormone anymore necessarily. So we don't have other influences, we can kind of get them dialed in. And women are like, then they're like, I'm back. I feel like I know what my body's doing now. So, so you know, as much as I love, you know, when I do have patients that need testosterone replacement, or we need to address that, it's so easy, but it's pretty easy. I tell my I tell my female patients.

SPEAKER_03 20:08

It is pretty easy.

SPEAKER_02 20:09

Yeah, comparatively, which is easy, which is why we invited you to come talk about those this beautiful mess.

SPEAKER_00 20:17

I tell my women, pay my female patients, it's like you know, the big wheels of 1980s, and you got the big wheel in the front, you got the progesterone, or you got the the two wheels on the back. Estrogen and progesterone are wheels in this tricycle. Testosterone's in there too. And can you imagine ripping the front wheel off your big wheel? You're not gonna go very far.

SPEAKER_02 20:37

If you if you rip one of the side wheels, you could I like this analogy, but I'm curious what then would be that awesome that little remember when they came out of that little side break that you do like the spin around move on the big wheel.

SPEAKER_00 20:50

Yeah, I don't know. That's probably like menopause. Like if we don't get it, I don't know.

SPEAKER_03 20:57

There's menopause. There it is. You can hit it any time.

SPEAKER_02 21:00

That's how you feel.

SPEAKER_00 21:01

Like, but if you rip one of those wheels off, and whichever wheel is the big wheel at what during your cycle, estrogen sometimes is the big wheel. Oh, now we've switched. Progesterone's the big wheel, meaning it's higher in levels, you know, and which one's the dominant one, you know, dominant hormone for that part of your cycle. If you rip one of those wheels off, you're not gonna go very far because women's bodies aren't men's bodies. We can't just throw a bunch of testosterone in them. Now we've there are some therapies and some theories that say you can, but really our my body's programmed, a woman's body is programmed to have all three hormones as balanced as we can get them with respect to the beautiful mess. Yeah. And so it's it's a lot more work, but it takes a lot more finesse for providers for sure.

SPEAKER_02 21:47

No, and it's important and this is it uh one of the things we've learned over these these last twenty two years, I guess.

SPEAKER_03 21:54

Well, and I think even before that, right? So we learned a bunch. We do we did a lot, yeah, we were doing it, and then we hit the brakes on everything. The so the so-called big wheel break.

SPEAKER_02 22:01

That was it. The women's initiative is the big break.

SPEAKER_03 22:04

Is the break. And then and then and then now it's like almost like we have to relearn it. So that's the one thing that I would uh point out, Caitlin, is that we talk about women's hormone replacement therapy like it's new, but it actually just popped. We it's actually been around since you know this like a you know, like strong ones since the 60s. Um and even a lot of the it sounds like a lot of the therapies they were using back even in the 60s, 70s, 80s were actually like really appropriate therapy when you're talking bioidentical hormones. We and then this one study once again just kind of upended everything. And and so it's it's kind of awesome to see that it's it is coming back. It's sad that we had to kind of regress, and and I I can't imagine the millions, I'm sure it's in the millions of women that have had to suffer because of that.

SPEAKER_02 22:50

That's what that so so that brought us to you know 20 years later, yeah. More research done, and and there's uh the book Estrogen Matters. I think that's 2023 that came out, uh not too long ago, yeah. Uh by Avram Burning. Uh so yeah, the book Estrogen Matters. Um and and and it's kind of a direct challenge to all the science in the women's health initiative. It's a big summary of why that study itself was um kind of the the fears that were generated were overstated, and and what really the evidence over these next 20 years has shown, um, and some of the things that were just simply wrong. And I think he makes that case that that millions of women um suffered needlessly as a result of not getting that beautiful mess set right during their perimenopausal years.

SPEAKER_00 23:50

Right. Well, and you all three of us have been in the ER when cute little ladies in their 70s, which you know in the 2000s would have been in their 50s, you know, so even 70s really isn't what I consider old anymore. So they were in their 50s, probably menopausal years, you know, when this women's health initiative came out. And we've seen these 70-year-olds come in, say, Oh, I barely fell into a doorway, or I sat down on my chair wrong, and they've broken their arm or they've broken their you know, vertebra, just from barely punching down a little hard on a chair or something. And it's horrifying. And then we'll do a bedside x-ray and we see that these bones are just swish cheese and just the preventative care, you know, breakdown with all of this. And I and I'm saying, you know, that's that's wonderful, even if that were true, even if breast cancer and all these things were true, and they'd kind of you know seen some of these things. There's some women who apparently, even in the 2000s, when the doctors called and said, Hey, I'm gonna take you off this, they said, You can do it over my dead body. I'd rather die of breast cancer. I was miserable. My relationships were breaking down. There, there was a small population that insisted, because we have medications with black box warnings on them all the time. And you know, people still take them. So, you know, so there's some strong women that said, I I almost lost my mind or I almost got divorced because my moods were so irregular, or I was miserable. How dare you? No, I'd rather die of breast cancer, which says a lot. And I still have women to this day say, Oh my goodness, like my life has changed so much in the last few months. Like, if for some reason I could never have this anymore, I don't know what I would do.

SPEAKER_02 25:34

So not only are we talking like we made miserable several years for millions of women, but we we've created an entire generation of elderly females who are not as healthy and far more frail than they should have been.

SPEAKER_00 25:50

And not just bone health, but we're talking we're getting chronic UTIs from vulvar atrophy, you know, all the parts down there change when they don't get good estrogen, it's not maintaining like its tissue shape, or you know, just just from all that. So there's a lot of women who come into the ER and they're getting UTIs chronically. They're on an antibiotic all day, every day, just to prevent these UTIs. So that's a that's a huge part too. And that's directly related to estrogen loss. You know, we've got metabolic disease, insulin resistance rising, we've got diabetes. I've even seen women come into me and say, Caitlin, I eat a Mediterranean diet, I eat fish, I eat organic, and I go walk and work out four to five times per week. Why is my cholesterol going up? And I say, Where are you at with your menopause? And they say, Oh, I've been menopausal for five or six years. And they say, Yeah, that's part of it, you know, because when we lose estrogen, everything shifts. Cells aren't happy, they're not at homeostasis, so nothing works as well. So yeah, it's not just that we're having this whole cohort of women who were in their 40s, 50s in the 2000s, now they're hitting 70s, you know, plus, and we're seeing them and they're having miserable and not to mention care issues because you know, now their adult kids are needing to take care of them. There's uh there's a whole discussion on it definitely trickles down.

SPEAKER_03 27:16

The one thing that uh that makes me think of is is, and then you think about it, it's even that much worse because you're like, hey, we found out um, you know, little little old lady, 70-year-old grandma never got put on hormone replacement therapy despite being symptomatic because they said it was going to give her breast cancer and everything else. So now she has these really thin bones, you know, whatever. She's her and her husband have struggled for 20 years because she just feels horrible, all these things that we, you know, predictably could have uh been prevented. Now you're in a situation to where you can't do it. Now those risks are significant because if if we find out their bones are thin and and we have uh significant osteoporosis, now now we're just stuck. Now you're like, oh sorry, that better.

SPEAKER_02 28:03

You're not gonna make that.

SPEAKER_03 28:07

And we have medications that we know can we chasing it with some yeah, some re-uptake and things like that. But it's you're really just so far behind the problem that we're just like, geez, I hope a strong wind doesn't come up and break your hip.

SPEAKER_00 28:20

Right. And you know, it's like spitting on a forest fire, like you're not gonna get very far.

SPEAKER_02 28:25

And I don't personally love which as a previous wilderness firefighter, but it doesn't work. It doesn't work.

SPEAKER_00 28:31

Neither does, you know, yeah, like it doesn't work. But I think that, you know, I am personally uh I would rather be preventative and proactive. I've been raised in a world where you don't just take a pill, you do things to prevent. You do your, you know, you do your regular.

SPEAKER_02 28:47

We're gonna get into a bunch of those things here a bit later as well. So so uh so now where would you say that our consensus is? I mean, it's my understanding now, kind of major medical organizations, including the menopause society, yeah, pretty much uh now strongly favor um hormone replacement. You know, it within 10 years of menopause onset, but but certainly not the blanket, oh no, don't do it. It's it's bad for you, you'll get cancer. Oh, yeah, it's much more individualized, and uh, you know, talk about women's age and the timing and their symptoms and their personal history and their goals, like but it, but but I think the consensus has now shifted or is shifting much more towards everybody agrees that this is a good thing at the right time.

SPEAKER_00 29:30

Right. And and the and the biggest thing is is what we learned what not to do, right, in the women's health initiative. And so we can we can very confidently say hormone replacement is safe for the majority of women. Now there's some contraindications if you've had an unprovoked DVT PE. So, like meaning we didn't just have surgery, we didn't just lay in a bed because we were ill, kind of things, clotting disorders.

SPEAKER_02 29:53

If we have breast cancer, a deep vein blood clot just out of the blue, not associated with it.

SPEAKER_00 29:58

If we've had a stroke, a heart attack, but really when you look at the population, very few people have had an unprovoked DVT that we can't explain, or PV, P E that we can't explain. Very few women have breast cancer in the grand scheme of women. The number one killer of women is not breast cancer, it's cardiovascular disease. Boom, bombshell. We have to prevent that, right? So it's so if we've got breast cancer, sure, we treat that smaller population. We say, hey, we got to do things a little different. Vaginal bleeding after menopause, we got to make sure there's nothing going on down there. We got it. We first things first, we got to make sure things are safe. History of stroke, history, recent heart attack, severe liver dysfunction. But really, when you look at all those things, you're like, you know, I don't know the exact numbers, but you know, the menopause Society of America says that's a very small population. So having a good conversation with women and saying, hey, this is safe for most women, overwhelmingly, but because, you know, and bless their hearts, these providers, these primary cares, they're so busy just trying to get people to take their diabetes meds and their blood pressure meds and just trying to get basic health stuff right. And they just they're losing time with patients because insurance is requiring more and more and HMOs are requiring more and more. So bless their hearts, they're doing a lot. But really, when these providers who are now practicing were going through med school 20 years ago and they were being taught through this women's health initiative that hormone replacement wasn't safe, that trickles into practice. And it's hard to relearn big guidelines with how that have such big implications. It's scary. No clinician wants to give their patient cancer. So changing the more we talk about it, the more we change that narrative, you know. Oh, you know, I'm I'm trying to do that right now so that my daughters have no problems with hormone replacement. Nobody even blinks an eye at it. But you'd be shocked how many women come into my clinic complaining of all these problems, the symptoms of menopause, but they're still scared to even talk about hormone replacement. And I don't push it, it's it's multiple.

SPEAKER_02 32:06

Not only with with uh patients, but with providers. I you you know, you mentioned when you went to medical school. It got me thinking 30 years ago, I was halfway through medical school. Like I'm in the middle of medical school 30 years ago, and now you and you know my son Pete, he's a podiatrist. Um he was started just a few years ago, and and uh I remember one one day he was on the phone, he was talking to me, and he says, He says, Dad, you know, we're learning, we're learning things that were like not even known, they weren't even discovered when when you went in medical school.

SPEAKER_01 32:38

Rude. And I'm like, oh my god.

SPEAKER_02 32:41

I'm that guy now, like right. It's and so it's it's not just I mean, it's not just the patient, like like your providers gonna need to keep up on this little bit. And it and it it takes some serious effort to kind of stay abreast of the information and how to best serve your patients.

SPEAKER_00 32:56

You would expect your cardiologist to keep up to date on you know, cardiovascular management, heart attacks, stroke, you know, you would expect them to, and this is a big primary care thing. Prevention, preventative health is primary care. And I and I suspect, you know, as the narrative changes and they this older population of providers, I'm not talking about you, Sorensen, but as this older population works out, and these newer, younger ones are coming on in, they're gonna be taught different things and it's gonna be like second nature to them. And that and I think that's what's gonna be the biggest difference for my kids. And I've already seen some providers that come out of medical school and they're just like, oh yeah, well, if you want to try it, let's try it. They feel a lot more comfortable, they feel a lot more comfortable asking for guide guidance from other practitioners that do it a little more often. But you know, it's yeah, it's it's gonna take time, but I'm I'm happy with what's even happening now.

SPEAKER_02 33:53

So awesome. Okay. Uh well, so so kind of summarizing that uh the women's health initiative study changed history. Uh but its interpretation has probably caused uh more or as much harm as it prevented. Um we now have some better science, better formulations, better understanding of timing, and uh and that's kind of reshaping what we have to offer women throughout the course of their life. Does that sound right?

SPEAKER_00 34:19

Absolutely, perfectly good.

SPEAKER_02 34:21

I think that's a good summary of of kind of the landscape of where we got to. We're gonna we're gonna kind of just cut and and and keep Caitlin on for some more information. We're gonna get into next time um sort of a little bit more detail about the the hormones over the course of a woman's lifetime. Um it's not as simple as just have some more testosterone, bro.

SPEAKER_00 34:45

I know.

SPEAKER_02 34:47

All right. Well, with that, um we will be back next week. Um