37. Is Menopausal Hormone Therapy Right for You?

Could menopausal hormone therapy be the key to a smoother transition through menopause?

Join us today, on this episode of the Thriving Through Menopause podcast as we uncover the truths about menopausal hormone therapy, focusing on its safety, effectiveness, and necessary risk assessments.

We'll explore the nuanced differences between estrogen-only treatments and combined estrogen-progesterone therapies, underscoring the vital need for progesterone in women with a uterus to ward off endometrial cancer. Learn about the various hormone delivery methods available, from patches to oral medications and topical applications, all tailored to individual needs.

Discover the benefits and potential side effects of bioidentical hormones, and how these therapies could assist with weight loss and reducing belly fat—two common concerns during menopause. Beyond hormone treatments, we’ll delve into non-hormonal options like certain antidepressants, blood pressure medications, and natural remedies such as evening primrose oil.

I will also share some personal experiences on managing hot flashes and night sweats, emphasizing the importance of personalized care.

Tune in to navigate the complexities of menopausal hormone therapy and make well-informed choices for your health.

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Transcript

Speaker 1: 0:00

Good morning again. Good morning my friends, welcome. Welcome to this video. Today we will approach that sensitive talk about hormone replacement therapy. It's what it was called previously. Right now, it is better known as menopausal hormone therapy. I will be bringing you information just to help you make an informed decision about yourself and your body. I don't have any bias in this video. I am not telling you exactly what to do. I just want to bring you information. So you are in menopause and if you are considering menopausal hormone therapy, you want to make an informed decision.

Speaker 2: 0:46

Welcome to the Thriving Through Menopause podcast. Dr Inaka Yembe, your host, is dedicated to helping you navigate the transformative journey of menopause and perimenopause, particularly focused on achieving menopausal weight loss and reducing belly fat. As a post-menopausal physician herself who has helped thousands of women experiencing the significant life stage, she understands the unique challenges you face. Listen in as we explore a wide range of topics aimed at supporting you in your health and wellness journey. Hopefully, the practical tips and strategies offered potentially help you adopt an empowering approach towards menopausal weight loss and belly fat reduction.

Speaker 1: 1:32

And now here's your host, dr Inaka Yembe. So today we'll talk specifically about safety, these menopausal hormone treatments. Are they safe or not? We'll be talking about that. I'll tell you what you need to think about when you're making that decision for yourself, so that it all boils down to your safety. There is a risk stratification that's important. I'll be talking about bioidentical hormones, just really really very briefly about what they are and why they are here. Just simple things that you should know, without going into any details on those and then of course, as you know, my biggest passion and journey for myself is weight loss.

Speaker 1: 2:13

So a hormone, these menopausal hormone treatments, will they help you with weight loss? That's one of the questions that I have. We'll talk about that and then, lastly, we will talk about some natural remedies. So, again, the reason why I'm bringing this information is just so you know you have some information. When you choose to do things with your body, it's your decision and yours only.

Speaker 1: 2:40

Generally, natural menopause is defined as the cessation of your menstrual cycles after 12 months, meaning if you don't have any cycles for 12 months, then you are in menopause at that time. Of course, there's surgical menopause, where, for some reason, you have your ovaries removed and then you go into menopause immediately. Naturally, most women go into menopause between the ages of 45 and 55. For me it was 47. I'm still facing the hot flashes and the night sweats and everything glorious that comes with the decline in estrogen. So that's really it Menopause.

Speaker 1: 3:22

The hallmark of menopause is the decline in the female hormone called estrogen. As those hormones if you're a female, you know what I'm talking about when the estrogen starts dropping, you feel all kinds of things Heart flashes, mood swings. If you're married, your husband says there's something wrong with you, lady. You're thinking, man, I am just fine. There may be something wrong with you, lady, you're thinking, man, I am just fine. There may be something wrong with you. But yes, those estrogens, they cause our moods to be up, down and everywhere, and for some women they can actually lead to anxiety and depression. We have poor sleep. Of course, if you're like me covers on, covers off, covers off, I'm hot, I'm drenched in sweat, I've got my towel, I'm just up and down all night long. That results in poor sleep, poor rest. Some women in menopause develop joint aches and pains. That could be a result of the declining hormones as well. And then some of us have that vaginal wall. It gets dry just when you're uncomfortable. You know what I mean? Hey, you know what I mean. So part of that is the declining level of estrogen. And then, of course, another thing that happens is your bones can get thin, and there are some theories, even though it's not specifically proven, but some theories say that this declining estrogen can cause dementia, it can lead to heart attacks and it can cause things like osteoporosis.

Speaker 1: 4:56

All right, now let's get a little bit technical and talk about safety, because why do women start thinking about menopausal hormone replacement therapy? It's because we've got all these things. They are in our day-to-day life. I mean, I went to get my lashes done yesterday and the lady took some towels and wiping my sweat. I was sweating like crazy. It was not hot in there, I mean, my hormones were just crazy and I was sweating, sweating, sweating. Unpredictable temperature, instability.

Speaker 1: 5:29

So when you get to that age of 45, 44, whatever it is, and you start experiencing these symptoms, this is when women generally take and run to the doctor and say doc, there is something wrong. I'm feeling all these things, can't sleep, can't do anything, I'm just having so much problems. So this is when women run to go to help. Again, the purpose of my talk today is not to sway you one way yes, for or against. My job today is just to bring you some information so you can make an informed decision. And why is it that women are now so hesitant?

Speaker 1: 6:10

In fact, as of 2002, the number of women who were using hormone replacement therapy, in addition to the number of doctors like myself who were prescribing it, declined quickly. Because that study, the Women Hormone Initiative, came out around 2002, and it demonstrated several, several adverse events around amongst this 27,000 women that were being studied. Around 2002, that study was halted where they were using placebo on some women and they were using hormone replacement therapy and they figured out that there were too many adverse events. Things like blood clots, heart attacks, strokes and breast cancer incidents was increasing, and so the study was stopped prematurely and the word went out. Now everybody knows or knew at that time that hormone replacement therapy was dangerous. I'm just bringing you the information that we have now in the medical journal.

Speaker 1: 7:12

So let's see who talks about this. The first person is the Endocrine Society, that's who puts out guidelines, and what they said is they actually recommend an individualized approach for women based on their cardiovascular risk factors. So if you are a woman who is going into menopause generally early, it is recommended early in menopause. So women younger than the age of 60, the endocrine society says yes, you qualify for hormone replacement therapy if your cardiovascular risk is below 10%, and I'll tell you how we figure out that risk. This is why in menopausal hormone replacement therapy there can never be one size fits all, because women's symptoms are different between one woman and the other and your cardiovascular risk factor is different from one person to another. This is why the endocrine society says the approach to prescription of hormones for women in menopause must be individualized. The studies actually show that now, if your risk factor is less than 5%, and especially if you are below the age of 60, you are safe to take menopausal hormone replacement therapy.

Speaker 1: 8:42

Okay, I'm 54. I'm not on hormones Disclaimer. I'm not on hormones Disclaimer. I'm not on hormones. My choice, my body, you've got your body. You make your choice. All right, if your risk, your cardiovascular risk, is between 5% and 10%, they call that moderate risk and you they recommend only transdermal, so maybe a patch on the skin and things like that, a vaginal estrogen, things like that. That's it, because you're moderate risk of cardiovascular events. Now, if your risk is greater than 10% maybe you're older and all these other factors, especially if you have a known heart attack, a stroke and you've got a malignancy, breast cancer or peripheral vascular disease, you fall into a high risk category and actually the hormone replacement therapy is not for you. It is not for you.

Speaker 1: 9:37

There are other things that we'll talk about towards the end. Now the endocrine society does say, because we women have these far-fetched, so many, many, many signs and symptoms that can affect our quality of life. Well, the endocrine society says that actually the benefit of menopausal hormone therapy outweighs the risk for women less than the age of 60. That is 6-0. Now let's talk about risk. So overall risk of hormonal therapy in younger women, like we said, is low.

Speaker 1: 10:18

However, it must be individualized. What are those risks that we are looking at? What are the side effects? What are the adverse effects that are major? Number one breast cancer. Number two venous thromboembolism. So heart. So blood clots and things like that. So blood clot. If you get a blood clot in your leg it can go to your heart, cause heart attack, go into your lungs, cause problems with breathing, major problems. You get a major blood clot in your lung can result in death. You get a blood clot that moves and actually goes to your brain. You get a stroke. So these are major adverse events.

Speaker 1: 10:58

Now how do we calculate it? And listen, I got all that written down here. Hang on, hang on, let me get my paper out. And I actually went ahead and calculated my risk. Remember, if it's less than 5% and you are less than the age of 60, hormone replacement therapy, if that's what you choose, could be safe for you. How do they calculate this risk? Number one your age, of course. The Women's Health Initiative study that was done in 2002 that was published, that affected all of us, was actually done mostly on older women. This is why they had so many adverse events. Now the study was continued for quite some time Not the study, but actually they went back 18 years after that study was halted and looked at the same women to see what their risks were and what problems they were having 18 years after the fact, and they realized that they were not having any more problems than the women out there who did not take any hormones.

Speaker 1: 12:03

But anyway, when you choose to go to your doctor to think about menopausal hormones, you want to first think about your cardiovascular risk. And how is that calculated? We've got a nice online calculator thing and we will be plugging in information. Your age, whether you're male or female yes, some men also take hormones. Your total cholesterol is plugged in there. Your good cholesterol, which is the hdl, is plugged in there. Your systolic blood pressure. So when you take your blood pressure, you've got a higher number and a lower number, so that higher number is plugged in there. Your race, whether you, whether you're black, white, pink, yellow, blue, purple, whatever color you are is plugged in there. Whether or not you are taking high blood pressure medicines is also taken into consideration, and whether or not you are diabetic is also taken into consideration.

Speaker 1: 13:04

And the very last thing listen. If you're smoking, smoking is a risk factor for everything. Listen, we are trained. If you see a question, you say smoking, smoking is the answer. Smoking is an independent risk factor for major diseases. And if you are smoking, please do not consider taking hormones. It just increases your risk so much more. So you've got all these factors that tell you that within the next 10 years, you have a 5% probability of developing heart attack or stroke, things like that. My probability as of today was calculated at 1.33%. Anyway, it's neither here nor there. I'm not taking hormones. Anyway, it's just my body, my choice. You have your body and your decision, your choice.

Speaker 1: 13:54

Now, the very interesting thing here, women, if you're considering menopausal hormones, is thinking about when to start. Thinking about when to start, and the studies do show that the women who start early have a higher risk of success and a lower chance of developing all these side effects. So, generally, the studies, many studies have shown that women should initiate menopausal hormone replacement therapy within the first 10 years. Now, 10 years is long. You've been toughening it out for 10 years. I mean your symptoms may be about to go away. Don't go to the doctor. I mean it just may go away. But when you start experiencing symptoms, you're late 40s. That's a good time. If your risk factor is low, studies show that you have a lower chance of having major problems. What are the problems that we're looking at? Everybody's symptom is different and everybody's reason for starting hormonal replacement therapy is different. That's why there are so many different ways and so many different kinds of hormonal replacement therapy. So now let's talk about the kinds based on the symptom.

Speaker 1: 15:08

Let's look at some symptoms. For example, if you're having hot flashes like me look that I'm about to have a hot flash Okay, I tell you what this stuff is real. So if you're having hot flashes this is overall temperature instability you probably need something systemic. Systemic means something by mouth. Systemic means something that will go through your whole body. Now, if your only problem, say, is things like well, I'm just having too many mood swings, or I'm just getting too anxious, I'm snapping at the children, snapping at the husband, I'm just an unpleasant person to be around, because you know menopause will do that to us sometimes. Well, maybe you may not even need hormones. Some antidepressants have a side effect of helping with hot flashes and may help you with anxiety and mood swings, so it just depends. Some women have poor sleep, joint pains, some women have vaginal dryness only Okay, you may go with just a topical gel or cream to apply in the vaginal area and that's it. So everybody's symptom is different.

Speaker 1: 16:20

So what kinds of hormone replacement therapies do we have out there? There's two main kinds, just two main kinds, and I'm not going to go into too many details. But there are two kinds of women. There are women who went into natural menopause because they got to a certain age and the ovaries stopped working. There are some women who had a surgical menopause because they had a hysterectomy with ovaries removed and then they immediately went into menopause. There are two different kinds of treatments estrogens or combined estrogens and progesterone.

Speaker 1: 16:55

It's important that you know that, even though your medical provider knows and they know what to prescribe for you, based on either estrogens or combined estrogens and progesterone, the biggest difference is that estrogens that hormone that's dropping we want to replace it, but if you have your uterus intact. Estrogens have a major, major, major ability to grow the inner lining of your uterus, to grow the inner lining of your uterus, make it thick and it can become disorganized and become atypical and expose you to endometrial cancer. So if you have a uterus, you should never take estrogens. Only your provider will probably give you estrogen and progesterone which immediately counteracts that growth of your endometria, so the inner lining of your uterus, and stops that process, and so you should be okay. But for women who have had a hysterectomy you can take estrogens alone. So your menopausal hormone therapy will either be estrogens or estrogens and progesterone. That's one big difference.

Speaker 1: 18:05

The second thing is that you may have, say, cyclical hormones. So you get a little nice big patch here or something on the card or whatever it is, and it'll give you hormones, say for like 12 days or 10 days, and then the next line is just placebo, nothing else, and then the hormones back again. All you know is that you're just taking everything as prescribed. Or some women actually have to take hormones for the first 12 days. Don't take anything after that. That's cyclical. It just depends on what you and your provider decide for you. Some women have to take something by mouth for these overall symptoms. Or some women can do with just a patch. Some women can take something implanted in the skin and some women can take topical.

Speaker 1: 18:51

Let's see, somebody had a hysterectomy with their ovaries intact. Do you know that was my situation. I was fine, I was fine. I was fine. I had a hysterectomy way, way, way long ago. Until the age of 47, I had no problems, and then my ovaries stopped working. I Until the age of 47, I had no problems, and then my ovaries stopped working. I was like, oh so, for seven years the hot flashes are here. So it's the same thing.

Speaker 1: 19:19

If you have your ovaries intact after hysterectomy so a partial hysterectomy you will still probably go into natural menopause at some point. All right, menopause at some point, all right. So it's either estrogen alone, combined estrogen and progesterone. For those women in menopause that still have a uterus, you can take something by mouth, something on your skin, some vaginal topical preparation, or something implanted in your skin. All right, let's talk about the other one that came up.

Speaker 1: 19:45

Question question Bioidentical hormones. So now, briefly, what are bioidentical hormones? Now, keep in mind I keep repeating. I almost sound like a broken record here, but I have to say I am not for or against hormones. I'm bringing you information. You take and make an informed decision on what's best for your body. Your choice, that's it. I do not take any hormones None, none, zero. That's why I still have the heart flashes. Guys still have the heart flashes.

Speaker 1: 20:20

So bioidentical hormones what are they? They are custom prepared compounded hormones. Most of them are prepared from soy plants. They have been structurally modified to be identical to the hormones that are produced by our bodies. So those are bioidentical hormones. Now let's look at what the smart guy says. Hormones. Now let's look at what the smart guy says.

Speaker 1: 20:50

These bioidentical hormones. They all of a sudden popped into circulation around 2002 when we had that women's health initiative study that was halted because of too many adverse events. Among this 27,000 women that were being studied and looking back at the statistics, most of the women in that study were older, but anyway, the bioidentical hormones surfaced in the market around that time. They claimed to be safer. Again, your body, your choice. But the fact is that the North American Menopause Society and the American College of Obstetrics and Gynecology, as well as the Endocrine Society, all they say is that there is no evidence that says that they are safer compared to the other compounds that are produced and are marketed as pharmaceuticals. There's no specific safety in the bioidentical hormones, but then again, they are used and traditionally, there are so many women who are benefiting from the prescribed menopausal hormone therapy and many women who are benefiting from the bioidentical hormones. Okay, so that's it, your body, your choice. But there is no specific study that says they definitely, definitely save far than the prescribed hormones.

Speaker 1: 22:20

All right, so now we are at a point where we talk about other therapies in addition to other remedies, natural remedies. The very first thing I'll tell you, number one please speak to your medical care provider. They know you, they know your numbers. So, before you ever join, jump and do something. Just because you heard it online or just because somebody is talking about it, you want to take and go to your medical provider so they can counsel you on what's best for your body. Very, very important, anyway, other non-hormonal treatments for menopausal symptoms. What are they? There are some antidepressants Anyway, I was saying antidepressants, some of these medicines, antidepressants they have been shown to have a side effect that helps with heart flashes. Antidepressants will do that. There are some blood pressure medicines. I'm not going to name any names here, but some of them we do prescribe for women to take at night. Take one at night why? Because they help with sleep and as a side effect, they also help prevent heart flashes and as a side effect, they also help prevent hot flashes.

Speaker 1: 23:38

Other natural remedies I'm going to jump straight into evening primrose oil and, before you go too far, they help with hot flashes and they can help with some menopausal symptoms. But evening primrose oil is notorious for multiple side effects. So women do not do it unless you take it to your doctor. That's a huge one, I see all the time. If you are taking antipsychotic medicines, if you're taking anticoagulants, if you are taking medications for seizures, if you have a bleeding disorder, evening primrose oil may not be safe for you. Please, please, take it to your doctor first. You don't have to believe me, but the studies show that evening primrose oil has a contraindication for people with seizures, especially if you're taking blood thinners, if you're taking adverse events. These medications interact with all these things and can cause major, major, major problems. That's even primrose oil helps with hot flashes but it's got some major side effects. You got to be careful with that one.

Speaker 1: 24:51

The next one is black cohosh. It shows to help with hot flashes and night sweats. I tried it. It did nothing for me. It didn't work. I didn't have any adverse effects, it just did not work period. I've tried it. It didn't work. I tried evening primrose oil as well. It didn't help me, but it has helped some women if you don't have any of those conditions we talked about.

Speaker 1: 25:14

Another one is soy. I've got mixed feelings and isoflavone, which is a phytoestrogen, so I'm mixed on that one. But the studies show that it helps with heart flashes. That's what they say. Next one is flaxseed. Flaxseed has the omega-3, omega-3 fatty acids. It may help some with what did they say? Because omega-3 fatty acids also act as phytoestrogens, so they may help with hot flashes. I generally tend to shy away from these soy products, specifically because of the phytoestrogen part. I do have a strong, strong, strong family history of breast cancer, so things that are high in soy I just shy away. A limit, that's just me. Like I said, your body, your choice to do for your body as you feel and as you know.

Speaker 1: 26:10

The next one is vitamin e. So now this vitamin e is more of a topical technicality. So if you have vaginal dryness as a female, you know, it just really gets uncomfortable. You know what I mean. Vaginal dryness in menopause is real. So try some vitamin E in the vaginal area. That will help your symptoms. It will help your symptoms. Next one is my all-time favorite Exercise Exercise, aerobic exercise. It will help your symptoms. Next one is my all-time favorite exercise exercise, aerobic exercise, breathing exercises, yoga. They just help with mood swings and help improve your sleep.

Speaker 1: 26:50

Last one, and again this is me. I go to sleep with my Yeti car. Don't judge me. It seems like I try to sleep and the hot flashes are here to welcome me. I say no hot flashes. We are not having a party, I am trying to sleep. So I have to go to sleep with my Yeti cup full of ice and water. I'm telling you, I'm jumping up, sweating drinking water. Women, you know what I mean. You know what I mean, but cold water has been shown to help with hot flashes. In addition to that, just drop down the temperature of the room. I tend to be cold natured, so I made this mistake earlier on until I learned the hard way. After a few years of hot flashes and seven years, my hot flashes are still here I've learned to drop the temperature down of my room, bring some ice water with me. I don't cover myself too much, even though I'm cold natured. That helps me get some sleep. I'm not saying a full night's sleep, but it helps some. So I think we have come to the end of everything here. I hope that this information helps you. I think. Oh, no, no, no, thank goodness I have my cheat sheet here.

Speaker 1: 28:04

The last one, the last thing we'll talk about is menopausal hormone therapy and weight loss. Since I am so big on weight loss, does it help lose weight? Does menopausal hormone therapy help with weight loss? All right, let's talk about estrogens. Exactly what happens when that estrogen level starts dropping? You know, we women, we have a lot of difficulty losing weight when you are postmenopausal, and it is real. It's not you, it's your body, it's your hormonal imbalance. So when the estrogen level drops, two things happen. A few things happen. Number one your lean muscle mass starts dropping. Because of that drop, your metabolic rate also drop. In addition to that, your body tends to build more fat, especially around the abdominal area. Those are the effects of estrogen. So it's just a should be a no-brainer that when you replace this hormone estrogen, you should lose weight. Right, wrong, wrong, wrong, wrong.

Speaker 1: 29:13

The studies do not show any specific weight loss with estrogen. In fact, the studies, what they say, is that estrogens may may help you maintain a healthy weight. So you're not just going to take a hormone and lose weight. You still need to be on a healthy lifestyle and, yes, because you have now replaced that hormone, estrogen, it may help you maintain a healthy weight. Now I did quite a bit of research on the bioidentical hormones and how they are dosed and things like that, and I did read up on some women who actually gained weight with this hormonal pellet that were being implanted, gained weight with this hormonal pellet that were being implanted and that bioidentical hormone.

Speaker 1: 30:07

Especially with the pellets. That's always an individualized therapy, meaning that they'll draw your blood and, based on your hormone levels, then they'll give you a pellet in your arm, your stomach, your hip and things like that, and some they implant a pellet right underneath your skin. What they recommend is to go with a lower dose. The lower the better. Why? Because estrogens and testosterone can cause a couple of things. It can cause water retention, so sometimes you take those hormones, you're gaining weight and it could just be water.

Speaker 1: 30:32

Testosterone is notorious for increasing your muscle mass. So, again, those hormones are just really tailored according to what your numbers show on your blood tests. But lower is also better. But no, just because you had an estrogen or testosterone replacement in a pellet form, you're not just going to automatically lose your 20, 30 pounds that you've been holding. You do want to go on a healthy lifestyle and then, yes, those hormones, because now your estrogen level is stabilized, it may help you maintain a healthy weight. I hope this information helped you. I have come to the end, everyone. I thank you, thank you, thank you for watching, thank you, thank you, bye.

Speaker 2: 31:21

Thank you for tuning in to this episode of Thriving Through Menopause. We hope you found valuable insights and practical advice to support your journey. If you enjoyed today's episode, be sure to subscribe to the podcast, share it and review. Your feedback is greatly appreciated. Remember, menopause doesn't have to be a challenge. It can be an opportunity for growth, renewal and self-care. Connect with us on social media, where we share additional resources, tips and advice to help you along your path. Once again, thanks for listening in and we hope you'll join us again on the next episode of Thriving Through Menopause. Until then,