Description
Menopause is a phase in a woman’s life that brings about hormonal changes with potential effects on various aspects of health. These changes can impact skin tone, muscle mass, fat distribution, libido, mood swings, cholesterol levels, and the risk of heart disease. However, the historical narrative surrounding Hormone Replacement Therapy (HRT) has created misconceptions and fear, largely influenced by the miscommunication of the findings from the WHI study in 2002, which reported an increased risk of breast cancer among HRT users.
This misrepresentation has persisted, limiting women’s access to potentially beneficial treatment options. It is important to be cautious of false narratives propagated through social media and celebrities, seeking reliable information sources instead. Consulting healthcare professionals specializing in menopause, such as endocrinologists, is crucial when considering relief options.
Additionally, careful research should be conducted before using vitamins and supplements marketed for menopause management. Hormone therapy is not a quick fix, requiring patience and informed guidance from knowledgeable healthcare providers. By navigating menopause with the right information and support, women can improve their overall well-being.
UPDATE 10-31-23: “Body Identical” and “Bioidentical” imply they are natural. This is a marketing ploy. These terms imply they are ‘safe’ since the terminology comes across as the same hormones in your body. If hormones were the same or similar, it does not mean a hormone is ‘safe’. Body Identical and Bioidentical hormones are made in a lab by semi-synthesis. In order for estradiol to be ‘natural’ we would be grinding up human ovaries to use.
@DrJenGunter
https://vajenda.substack.com/
Book Details
Outline
- Introduction
- Definition and impact of menopause
- Historical Narrative
- Negative perception of Hormone Replacement Therapy (HRT)
- Woman’s Health Initiative (WHI) study and its misrepresentation
- Influence on women’s choices and healthcare providers’ prescribing practices
- Filling the Gap & False Narratives
- Introduction of Bio-identical Hormone Replacement
- Therapy (BHRT) by Big Natural
- Caution against false narratives fueled by social media, celebrities, and product providers
- Can Anyone Help?
- Importance of considering the condition to be treated
- Availability and expertise of OBGYNs and endocrinologists
- Challenges in finding appointments with endocrinologists
- Prescriptions
- Effectiveness of Premarin for treating menopausal symptoms
- Introduction of Veozah as a repurposed drug
- Safety considerations and limitations of long-term use
- Alternatives
- Popularity and considerations of “bio-identical” hormones
- Evaluation of claims regarding safety and effectiveness
- Delivery Methods
- Considerations and drawbacks of oral estradiol
- Other methods such as gels, sprays, emulsions, injectables, and pellets
- Progesterone
- Importance of using progesterone with estrogen in hormone therapy
- Protection of the uterus lining and prevention of menstrual bleeding
- Conclusion
- Understanding hormone therapy as a process, not a quick fix
- Importance of consulting knowledgeable healthcare providers
- Navigating menopause and improving overall well-being
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Sources:
New study finds kelp can reduce level of hormone related to breast cancer risk
What is Estrogen Dominance As A Hormonal Imbalance in Women?
The Menopause Manifesto: Own Your Health with Facts and Feminism by Dr. Jen Gunter
Estradiol Side Effects: Capsule, Cream, Vaginal Insert
New study finds kelp can reduce level of hormone related to breast cancer risk
The North American Menopause Society Video Series 2023
International IMS Menopause Society
International Society for the Study of Women’s Sexual Health
Susan Davis Is testosterone the answer to low libido | INTERVIEWS WITH MARLA SHAPIRO – for women
Welcome to Swinger University
Ed: Hi, I’m Ed.
Phoebe: And I’m Phoebe.
Have you ever wondered if hormone replacement therapy or bioidentical hormone replacement therapy is right for you? Phoebe had to really dig to find information. She started with her primary care provider, went to her OB-GYN, and then to an endocrinologist. She read books, listened to podcasts, interviewed at least 10 doctors, and talked to all of her women friends. While I have put in hours—yes, hundreds—into my research, however, I’m not an expert. To be an expert, you need 10,000 hours, and I’ve not come close to 10,000 hours. But I’m on my way there. So please know this episode is information I’ve organized for you through my filter and my cumulative experiences.
There seem to be two camps of perspectives when dealing with menopause and helping women with those symptoms. You have doctors prescribing for relief of symptoms like hot flashes and night sweats, and you have doctors prescribing for long-term health benefits, quality of life, better libido, etc. So, we are going to break all that down in this episode.
In addition to this episode, we’ve also put together two blog posts for this: “How do you know if testosterone therapy is right for you?” and “Hormone replacement therapy for men.” Consider subscribing to our channel so you don’t miss any of our episodes. Check out the podcast because we have sexy extra content that you won’t get here on YouTube. If you like our show, tell a friend about it. Every new subscriber helps boost our show and draw in new listeners.
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We are trying our darndest. I will tell you, this episode has been coming for about, well, over a year—yes, about two and a half years. Well, you certainly have been doing your research for that long. But talking about producing the episode, we were going to kick it off in November, right after we got off the cruise. We’d even talked to some people on the cruise about the episode, and everything keeps shifting around. We keep finding new information that kind of contradicts the previous information and starts the ball rolling again with more research.
And my research started very small, about the size of a cherry—let’s use fruit as an analogy. And then it grew to the size of a grapefruit, and then all of a sudden, it exploded to the size of a watermelon. And then I realized I had so much information that there’s no way I could organize all of the information for everybody and not bore them to death. It’s a book—I mean, it really is a book. It could be an entire volume of books. So now I’ve tried to shrink it back down to about the size of an orange, and it’s still a lot more information than I feel like people need, but then I feel like you really need it because it’s all really good. And there are probably, I don’t know, 15, 17 websites and references that I’ve provided for people to do your own research.
So the goal of this podcast is I’m giving you resources and I’m giving you the information that I collected to help guide you in the direction that might be right for you. Because I can’t address everybody’s medical issues and their unique body performance with hormones, which is a whole other topic. I had to simplify it back down to the orange level.
Yeah, I mean, if you consider it, every single person’s chemistry, biology, physiology is different. And trying to—even for a doctor—prescribe one solution for every body, literally every body, yes, not possible, which is why they call it the practice of medicine. Because while doctors are educated and they have scientific studies, scientific studies are constantly being reviewed, studies are being redone, and not everything fits everybody, right? You’re practicing what fits the average person. And right, I’m not the average person. And what works for most does not typically work for me, I discovered.
So let’s launch into this. Most of us women in the lifestyle, although there’s a growing community of younger women in the lifestyle now, and I’m super happy about that. And thankfully, you don’t have menopause issues now or perimenopause issues. But these are the flashes, emotional changes, brain fog, dryness, weight gain, you can’t sleep, you’re sweaty, your sex hurts because you’re dry. And then you have vaginal pH issues, which do change when you’re perimenopausal and menopausal. Usually, your pH is 5.5, and it can lower to 3.8 or 4.5. And the reason I bring this up is because this gets to be a little more important when you’re swinging and having multiple partners. You’re introducing other types of bacteria from other partners, different safety levels of different partners depending on where they play and who they play with. And you’re introducing other new factors as well—condom use, which is irritating, can be drying, different lubes that you didn’t normally use, which can be irritating and drying. So there’s all these different factors that tend to mess up your nice vaginal health just because you’re perimenopausal or in menopause.
So along with all of those perimenopause and menopause symptoms, the practice of hormone replacement therapy is really trying to alleviate a lot of those symptoms. They’ll also help with some of these other things like skin tone, muscle building, fat, libido, depression, mood. Even cholesterol can be affected by hormones, heart disease, bone density. So some of those long-term benefits that you were talking about with hormone replacement therapy are addressed with these, which is that long-term getting back to where you were when you were producing hormones naturally on your own.
And a lot of doctors are selling this sort of Fountain of Youth. You have to be a little bit careful. HRT has had a negative stigma attached to it because of some studies that were done in the early 2000s. Statistics lie. People blow statistics up and misinterpret them all the time, which is why statistics are really hard to read and interpret because of the way that those statistics were interpreted by the media. It shifted the way that hormone replacement therapy was interpreted by the public and doctors and the media, and it’s only just now starting to be clarified, figured out. A lot of people know the ugly word Premarin, right? Horse urine. And this hormone replacement therapy is still prescribed today. A lot of people don’t know that, and it was good, and it is still good, actually, for hot flashes, night sweats, and vaginal symptoms. It was off the market in 2002 because of some of these false claims and misinterpretation of some of the premature data that was released when the study wasn’t even finished, right? So things really kind of got jacked up for women. And what I found was that it’s really the only natural estrogen, and it’s still being prescribed to one million people. And it’s still marketed as safe as long as it’s used with progestin. Now, most people don’t use it long term. Most doctors prescribe this for three to five years in that perimenopause or menopause, really as a symptom relief for hot flashes and things like that. They don’t like to prescribe it long term. I’m not sure why, maybe because it’s used as an oral estrogen and not as an estradiol. There is a difference. So there’s a lot of different factors, and that’s really important to keep track of. Estrogen is different than estradiol. In fact, there are two other types of estrogen, but hormones get complicated. Hormones get really complicated and how they work with all the other parts of your body. By the way, there is a new drug on the market as of this year that’s called VEOZA—V E O Z A H. It’s a Gabapentin repurposed as this new drug, and it was originally used for pain relief and seizures. They’re finding that it sits on the brain receptors telling the body that it’s not really hot and it’s not really cold.
Oh, interesting. It stops the body from responding. The body thinks it senses this drop in hormones in the evening as part of your natural circadian rhythm cycle, and your body thinks something’s wrong, and it seeks to adapt by increasing your temperature. And therefore, you’re getting these flashes of hot and sweat. So it tells your brain, “No, no, no. You’re fine. Please don’t do that.” Nice. So very nice. So I was just recently at my OB-GYN, and she said people are flying in for this prescription. I have no idea how much it costs right now because I haven’t had her send that to the pharmacy. But hopefully, it’s affordable enough for people to take it and get a good night’s sleep.
Phoebe: What other options do you have for this type of relief? And hopefully, you’re going to your OB-GYN or an endocrinologist. Endocrinologists are a little bit better, but they’re rare to find. There aren’t very many that have gone to school and are practicing. And if you do find one, probably takes a good five to six months to get an appointment, which was my case. I would say finding the right doctor is key. Doing your research and finding out which methods are going to be right for you. And I’m going to go into the pellets, the creams, the injectables, all that type of hormone replacement therapy if you want to go with that type of replacement instead of just the medicine to stop the hot flash. That’s different. Big natural saw an opportunity when there’s this huge gap when people weren’t using Premarin, and there was this big scare that, “Oh my God, it causes cancer.” So women were suffering for years trying to find something, and big natural said, “Oh, we have something as an alternative,” which is bioidentical hormones.
Okay. Well, what’s that? Well, it’s actually been around since the ’90s, and they didn’t really come out as a product until right after this Premarin scare. Right. They’re not actually identical. They are—the starting compound is found in plants and animals, but they are still chemically altered, and they are a different isotope to your body. So please don’t let people tell you they are identical to your own hormones. They are not identical. In fact, Premarin is probably the more closer identical hormone to your body, which is very interesting. Back to the estradiol. It is made by your ovaries. It can be synthesized from yams. It’s a semi-synthesis, but it is not identical. It is plant-based, but is it 100% safe? No. So when someone tells you, “And it’s all-natural. It must be good for you,” it doesn’t necessarily mean that your body processes it the same way or deals with it the same way. And there’s all kinds of natural things that, if you ingest it, will kill you because it’s been altered. Right. It’s not an actual yam. It’s been altered to be assimilated by your body.
Estradiol and progesterone are two of the more common uses for hormone replacement therapy. A lot of doctors will use testosterone as well, and we’re going to do an episode and a blog on that. Right now, we’re going to focus on the estradiol and progesterone. Estradiol can come in many forms. You can have an oral method, which is in a pill or a lozenge. The oral pill will pass or lozenges will pass through your intestines, your liver, and then into your bloodstream where it gets diluted. So you typically need higher doses of estradiol in order to have the same effect. One of the negative things about the pill or oral version of estradiol is that it can trigger the liver to make estrone, which is a weaker form of estrogen, not estriol. And it creates more proteins and can be known to cause more blood clotting. It also increases the SHBG made by your liver, which binds more testosterone. So it’s a little less effective or active in your body and can create a negative effect on your libido. So to encourage you to do your research, I do have some good friends that use the oral version. They say they don’t have any issues. I haven’t got into great depth and detailed on their test results and what exactly their medical history is, but they seem to like it. And that’s a risk factor that you’ll have to decide for yourself. I’ve decided personally I don’t want to take it. I want to do something different.
Estradiol can lower your cholesterol, but it can tend to raise your triglycerides, so you may want to be cautious of that. This is the oral form of estradiol, and it has some inconsistency where your levels are up and down based on your digestive process. It tends to impact your mood levels differently because you might be sensitive to fluctuations. It could have some inflammatory reactions and increase cardiovascular disease. I’ve heard more negative things from oral estradiol than positive, but you know, that is what I have found. You can do your own research on the rest — gels, sprays, and emulsions. You can apply those daily, typically to your arms. Some say yes, some say never. I more frequently hear people say you apply it to your hip and buttock region, even the outer thigh. That is the preferred method. The downside is that you can’t wash it off. You can’t apply moisturizer or sunscreen right over the top of it until it takes that hour to absorb. Also, you can’t have sex with your partner because it’s on your skin, and it can transfer. So, you do need to wait. It seems a little messy for me.
Very specific pellets seem to be the up-and-coming easy way to go about delivering estradiol and testosterone. It looks like about a cooked grain of rice. It can be inserted into your lower hip and buttock region. The only downside is you have to wait about three days to exercise because you’ve got to wait for that incision to heal. You can’t get in the hot tub; it’s covered with a patch and that waterproof patch. The benefit is it has a slow time release, so you get more of that even dispensing of the product — estradiol or testosterone — into your body.
Progesterone, however, is a pill, and that is pretty much the common. I don’t know of any other way to prescribe progesterone. It seems like that it’s a pill, and that’s the way it’s done. It will be necessary to take that if you’re on estradiol because it affects the lining of the uterus, and you don’t want to bleed while on estradiol. So, it balances out, keeping your lining from shedding.
Now, I will say some doctors in Europe will prescribe a more natural balance of estradiol and progesterone to females so that they have a cycle in menopause. So that it mimics more the natural cycle of the woman. There are camps that say yay, there are camps that say nay. So, you may want to choose what’s best for you.
One of the things that I remember from the pellets — and this is pretty important if you want to consider delivery methods — is it’s a surgical procedure. They cut you open with a scalpel, and they shove a steel tube into your body and push, like a syringe, those pellets into you. It looked like a very long, it was like a steel straw, yeah. It was like a spoon almost, a long spoon, like a two-inch long narrow spoon. If you’ve ever looked at a hypodermic needle really close up, like under a microscope, it’s a straw cut off at an angle. That’s kind of what they’re doing — pushing a very large needle into you and then pushing the pellet out through the tube into your butt. I had it done with my testosterone pellet, and it hurts. It’s very invasive. Yeah, it’s invasive, and then they do use a butterfly suture, not a suture; they don’t actually suture you up, but they tape you closed again. Tape sutures, yeah. It takes a while for it to heal. I mean, you did mention that you couldn’t exercise, but for men, it’s more invasive, and it takes longer to heal because the pellets are bigger, and there’s more of them for testosterone. So, the incision’s bigger too. It’s literally a pain in the ass. Yes, and you also end up with a really nice set of scars as you progress. Yes, the more often you do it every four months, you will have a new scar to add to your collection, which is super fun. There was a woman I talked to that had done it for 10 years now, and she has little hard spots, scars, oh yeah. So, when you touch her ass, she’s got little bumps. She has bumps everywhere. You don’t see them, but you can feel them. Yeah, and she jokes because she says she’s running out of places to put incisions. Sounds lovely. I remember it and don’t have fond memories of it, right?
Another delivery mechanism is actually daily injections. So, you have a small vial of fluid, and you draw out that fluid to the volume that they prescribe to you. You use a little alcohol wipe, you swab your part where you inject and stick basically a hypodermic needle like an insulin needle into your butt and inject the hormone right. You can do it with estradiol and testosterone. You can do it daily. I’m not sure if you would want to do it every other day, but you might be able to. For me, the key is to have a more level balance of hormones in my body that’s going to mimic my normal body’s response. It makes sense. It keeps your mood more balanced; you’re not having these high peaks and low lows. To me, it just makes sense. So, if you’re okay with injecting yourself daily and you’re not afraid of needles, that could also be a good way to go. I will say it’s hard to find. A lot of local providers do not offer this. I found a few that offer it online, and part of the reason is it’s covered by insurance, mostly usually. They’re not making any money off of it, and that’s interesting.
Yes, but it’s also the downside is it’s not very convenient, meaning you have to do it daily. You have to carry it with you on vacations and any kind of activity that you’re going to. If you’re going to a pool party, you’ve already done it in the morning. But if you’re going backpacking, for example, like we do, you had to find a special case, right, to carry it. It is an insulin case, which is fine. Thank goodness it doesn’t need to be refrigerated, not for testosterone, but I don’t know for estradiol yet. That’s true.
I’ve gotten into that. This could be an inconvenience factor. I would encourage you to have patience because this is not a quick fix. The lower the dose of hormone therapy, the longer it takes to take effect in the body. So, patience is key, and it’s typically four to eight weeks before you start to notice changes. With lower doses, sometimes it takes even longer.
Another piece I’ll throw in with patience, and this speaks more to not the immediate effect of how long it’ll take to kick in, but getting the dosage right has been a struggle for you for years. You’ve been to several providers; you’ve talked to all the doctors. I mean, our whole intro kind of covered the long road that you’ve been on just trying to figure out what the right dose is for all of these different hormones. Don’t go into it with the expectation that they’re going to get it right the first time. It’s going to take some trial and error. It’s also going to take some testing, so they’re going to take blood tests and figure out where your levels are periodically after it’s been in your system for a while, especially with pellets. It’s a slow release; you gotta wait a little while. You’re not going to find out right away if you got it right or wrong, and then they’re going to have to adjust your dose, and then they’re going to have to test you again. It takes a long time.
It does take a long time, and you mentioned the testing with or the pellet. If they’ve given you the wrong dosage, you have to wait three or four months, right? If it’s too high, you’re suffering. If it’s too low, they could supplement it with a cream or something different or an oral medication to kind of balance it, but then it’s complicated because the delivery method means that it gets absorbed differently, and your body processes it differently. So when you go back for the next pellet with the higher dose, that may not be the right dose either because the cream was absorbed at a different rate, and it was probably a different level of dosage, right? And this is why it gets so complicated and so frustrating. So, you really have to ask yourself what the price you’re willing to pay for the type of relief that you are looking for. Are you just looking for hot flash relief, night sweat relief? Or are you looking for longevity and the promise of that? If you are, it’s going to take some trial and error to get the right dosage for you. Most doctors will only order tests a few times a year. I have them order it every single time I go in because they’re guessing, and I don’t want them to guess. So, I’m willing to pay. It’s only like 80, 90 bucks for each test. It’s not like 250. I’m willing to pay that to get exact test results, right? To figure out where I need to be. And even then, it’s still a frustrating guessing process. Yeah, but it’s closer. You’ve decided, “I want this. I want better muscle tone. I want better sleep. I want to live longer. I don’t want osteoporosis. I don’t want any of these other bad things. I want more energy, and I want what they’re promising me.” The social media doctors, my friends, whatever. They’re saying, “Oh my God, I can get testosterone and be hornier.” So, who do you go to? Be careful because what’s happened is that pretty much any licensed doctor can prescribe you bioidentical hormones. It could be an anesthesiologist who doesn’t want to be an anesthesiologist anymore. It could be a general practitioner. Some nurse practitioners can do so, especially in states that have those types of requirements. They’re promising some of the same things that Premarin did — prevention of cardiovascular disease, osteoporosis, breast cancer, reducing blood clots, all that stuff I mentioned before.
Here’s the problem. Sometimes the doctors are getting most of their information from the entity that’s selling them the product. So, they decide, “Oh, I want to change my business model. I don’t want to be an anesthesiologist anymore. I want to get onto this bioidentical hormone replacement bandwagon — money-maker kind of thing.” So, they go, they take a class from XYZ pellet manufacturer or cream manufacturer, and they give them a cloud. They pay for a class, and they take their training, and then they set up shop, and all of a sudden, they get the product at their place, and boom, off they go. Well, they’re given some pretty standard levels of care, and they’re not really educating themselves on all the different facets that come with each individual’s needs, even though they say they will. This really comes from my experience of having talked with 10 doctors and been a patient of four different doctors. So, I’m telling you this just to kind of be aware of some of the information that you may hear in social media on different podcasts. Take the information and critically analyze it for you. It is a lot of information. It’s not going to be easy. It will be unique to you. Menopause is a significant phase in a woman’s life that can present various challenges. While seeking treatment options, it’s essential to consult knowledgeable healthcare professionals and providers and be cautious of misleading information. By gaining a better understanding of menopause, its symptoms, and available treatment options, you can navigate this transitional phase more effectively and improve your overall well-being.
Thank you.