Hello Menopause

Summer Short: Dr. Avrum Bluming & Dr. Carol Tavris (Estrogen Matters)

Full episode available at letstalkmenopause.org and wherever you get your podcasts.

STACY LONDON (INTRO)

Hey everyone, Stacy London here. Season 4 of Hello Menopause is taking a quick summer breather, but we are not leaving you hanging. All summer long, we're dropping Summer Shorts — bite-sized episodes every other week, our most-loved conversations, plus a few brand-new voices. Real talk, real experts. We're back in September with all-new episodes. Have a great summer.

This Summer Short features Dr. Avrum Bluming and Dr. Carol Tavris. Go to letstalkmenopause.org or wherever you get your podcasts to listen to the full episode.

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STACY LONDON

Let me ask you a question: what do you think the biggest misconceptions around HRT are, and why do they persist?

DR. AVRUM BLUMING

Oh, just... just that.

STACY LONDON

Just that. Yeah, I mean, I thought we'd open with something small and really easy to answer.

DR. AVRUM BLUMING

Well, I think the biggest fear about hormone replacement therapy is its association with breast cancer. I think that fear is periodically stoked on a regular basis. If it isn't breast cancer, it's ovarian cancer. If it isn't ovarian cancer, there was even an article, a presentation, relating hormones to lung cancer or lung cancer deaths — all of which are not true. But every time somebody waves that red flag in a theater, people pay attention.

And in case you thought that there was a reason to take hormones — when the Women's Health Initiative first published their results in July of 2002, they said it really doesn't do anything good, and it does a lot of bad things. It increases the risk of heart disease. It increases the risk of death. It increases the risk of strokes. And by the way, they said a little over a year and a half later, it has no effect on quality of life.

Well, two things about that. First, yes — the median age of the women was 63, and half were overweight or obese, and a significant number were smokers. It wasn't directly representative of the population, but the data that they collected was fine. They misrepresented their own data.

DR. CAROL TAVRIS

Okay, so you have to back up a step. You said 20 years ago, it's like that's old times. Well, it's not old times. A generation of doctors came of age in medical school learning that hormone therapy for women in menopause is going to cause cancer and many other dire things, and it's not beneficial. That's what they learned in medical school. It became the guidelines for their various specialties.

We hear over and over from women going to their doctor saying, “I want to take estrogen,” and the doctor says, “No, it could kill you, and I can't harm my patient, and I won't give you hormones.” And they say, “But look at the data — look at the Women's Health Initiative having changed its mind.” “No, I can't and won't.” And so we hear over and over from women who are getting this message reinforced by doctors who have not kept up with the Women's Health Initiative's own retractions, or with the new contradictory evidence.

Now, that's not unusual in medicine. Doctors have a lot to do, and they're very busy, and they don't want women coming into their offices saying, “Hey, pay attention to me” — which is fair, okay? But when you say, why are women so frightened? They're frightened for two reasons. First, because when the Women's Health Initiative launched this bombshell press conference, it scared the bejesus out of everyone — out of doctors, out of—

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STACY LONDON

I do wonder, when you talk about fear — I think that's absolutely right. Fear, whether it's a vaccine, whether it's a hormone, anything. I think there's also this cultural implication, this sociobiological and cultural implication that we're sort of expired, right? This is our sell-by date.

One of the things I find so interesting, in speaking with women who — like myself — it took me seven years to fight to get on hormones. I fought with every doctor that I had. They said, “No, no, your father died of heart disease, it's a bad idea.” Well, he died of heart disease that was not genetic — it was completely out of nowhere. My mom had a stroke, again for a very specific reason — strokes do not run in our family. We had no breast cancer in my family. But they told me, because of those two things, and because I had an autoimmune disease, that I should not go on hormones. And finally, after seven years of sleeping four hours a night, and literally driving almost every person out of my life—

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DR. CAROL TAVRIS

So, first of all — you know more than most doctors do, who learn about zero in menopause when they're in medical school, as you well know. And the point you've just made is also something most doctors don't know, which is the variety of symptoms associated with perimenopause and menopause. Women go to a rheumatologist, then they go to a cardiologist, then they go to a psychotherapist, and they go to every other specialist, because they've got these symptoms — all of which are related to the depletion of estrogen around this time.

But do doctors know this? Cardiologists aren't thinking, for the most part, “Gee, I've got this patient with heart palpitations, but her heart's completely fine — could she be in menopause?” They aren't trained to look for that explanation, and that is indeed one of the concerns.

DR. AVRUM BLUMING

One of the things we've discovered is less than 25% of OB-GYN fellowships spend any time on menopause. And the ones that teach anything about menopause often teach for a few hours, over a several-year training period. So many doctors walk into that situation not well prepared to deal with it. And it's easier to say no than to say, “I'll look into it.”

DR. CAROL TAVRIS

Avrum, this one's for you. This is the great question I was asked at that meeting, by the 50-year-old woman who said, “Well, I have no symptoms — should I be taking hormones now?”

DR. AVRUM BLUMING

Well, let's talk about what we know about hormones. We know that seven times as many women die of heart disease as die of breast cancer in the United States every year. The leading cause of death among women with breast cancer is heart disease — not breast cancer. Newly diagnosed breast cancer today carries between a 95 and a 98% cure rate.

And that doesn't mean we shouldn't fear breast cancer — some people do die of it, 42,000 a year in the United States. It's a serious issue, and being an oncologist, I recognize it as a serious issue. But it's dwarfed by heart disease and heart disease death. We — and the Women's Health Initiative team agree, as do cardiologists around the world — that estrogen decreases the risk of serious heart disease by 50%, and decreases the risk of death from serious heart disease by approximately that amount.

Osteoporotic hip fracture kills almost as many women in this country each year as heart disease, as breast cancer does. And the best treatment to prevent osteoporotic hip fracture is estrogen, which decreases that risk by 50%.

If there's one thing women are more worried about than cancer, it's cognitive decline — Alzheimer's disease. There is no treatment for Alzheimer's disease. Two-thirds of Alzheimer's disease patients are women. And there are numerous reports in the medical literature that show hormone therapy started around the age of menopause will decrease the incidence of cognitive decline by between 25% and 65%, depending on which study you want to cite. And on all of these, the Women's Health Initiative agrees with the data I've just mentioned.

In addition, longevity is improved by taking hormones — and they agree with that, and have published that as well.

DR. CAROL TAVRIS

What individual women can do — and this is, in fact, a big difference for your generation, Stacy — is that women are more vocal and more active and more demanding. This happens, of course, for any group when they suddenly realize there's a problem that's not just affecting them, but all of us in this boat, and we want to get in the boat together and steer it in the right direction.

What individual women can do, need to do, and are doing, is getting noisier about what they're entitled to from their doctors. I'm entitled to respect. I'm entitled to your listening to me. I'm entitled to telling you my symptoms, and discussing a treatment program between us. They want to be heard. They want their complaints known.

But if women can inform themselves — starting with what menopause is, and what hormones do, and why the depletion of estrogen is causing the symptoms you're feeling — that, right away, is the most energizing... and the word Avrum and I laugh about often, empowering. But it is the word. Because once you understand why your body is reacting this way, you realize it's not that it's all in your head and you're crazy — it's your body's natural reaction to a depletion of estrogen. So women need to inform themselves, not with the easiest answers, but the good basic information.

DR. AVRUM BLUMING

When people say, “How long should I take hormones?” — the standard, incorrect answer is the lowest dose for the shortest period of time. What we say repeatedly in the book is there is no support for that oft-repeated statement. In fact, once you stop taking hormones, the benefits leave your body relatively quickly. So while estrogen will decrease the risk of an osteoporotic fracture by 50% while you're taking it — within five years of stopping estrogen, your risk of that fracture is as if you had never taken it at all.

And so, like thyroid hormone — which once you're put on, you take for the rest of your life — the default position should be: once you're taking it, don't stop. There's no strong indication to stop unless something comes up, and that's why we don't give advice to a broad population of people we haven't evaluated individually. This has to be discussed with your doctor. But once you start it, hold on to it, unless there's a very good reason to stop.

And you're allowed to challenge your doctor's initial refusal to start it, or your doctor's insistence that it be stopped, or your doctor's efforts to get you off it for some abstract reason that isn't spelled out. And if the doctor does spell it out, it can often be deflected by data — by good data.

STACY LONDON

It has been such a pleasure to talk to you. Now, I just want to make sure everybody knows where they can find you. Not everybody can be friends with you or come to lunch like I can, but I do want people to know where they can find your work and where to find you on social media. So Carol, why don't you go first?

DR. CAROL TAVRIS

Okay — well, the website, estrogenmatters.com. They'll get basic stuff, also how to contact us. And we will reply always. And our Instagram account also, Estrogen Matters.

DR. AVRUM BLUMING

Well, if you write to info@estrogenmatters.com, we respond to every email we get — every single one, and we have for the last nine years.

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Hello Menopause is produced by Studio Kairos. Learn more about Dr. Bluming and Dr. Tavris's book, Estrogen Matters, at estrogenmatters.com.

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