<p>In this episode, Avrum Bluming, hematologist, medical oncologist, and emeritus clinical professor at USC and Carol Tavris, social psychologist and author of Mistakes Were Made (But Not By Me), discuss their collaboration on their recent book, Estrogen Matters. Their book takes on the very polarizing and confusing topic of hormone replacement therapy for women suffering with symptoms of menopause. In many ways, the story and history of HRT is in striking parallel to the bad science that led up to the dietary guidelines being set forth in 1980. Carol and Avrum make a compelling case that most women benefit greatly from being on postmenopausal hormone replacement therapy, and can do so without increasing their risk of breast cancer. We also cover the history of HRT, the impact of the Women's Health Initiative, and take a deep dive into each of the clinical conditions for which HRT should be considered, such as cardiovascular disease, neurodegenerative disease, and osteoporosis, to name a few.</p> <div> <div> <p>We discuss:</p> </div> </div> <div> <ul> <li>The background of Carol and Avrum, and the impetus for writing Estrogen Matters [8:45];</li> <li>The sad early history of hormone replacement therapy, treatments for prostate and breast cancer, and the difference between the treatment of women vs. men [14:00];</li> <li>What hormones do, and why they drop off rapidly in women compared to gradually in men [20:15];</li> <li>Mistreatment of women leading to great skepticism [23:45];</li> <li>Breast cancer vs heart disease: Comparing the incidence and mortality in women [27:00];</li> <li>Case studies of women suffering symptoms of menopause [30:00];</li> <li>What are Carol and Avrum's true motivations in this endeavor? [32:45];</li> <li>The changing perceptions of HRT, the impact of the Women's Health Initiative (WHI), and the problems with the WHI [37:45];</li> <li>Is this one big conspiracy? The uncanny resemblance of the story of HRT and how the dietary guidelines were created [46:00];</li> <li>Why people (falsely) think estrogen causes a 25% increase in breast cancer, and a lesson in absolute vs. relative risk [57:15];</li> <li>The truth about progesterone and cancer risk, and the best types of estrogen and progesterone to be taking [1:09:00];</li> <li>The Women's Health Initiative: the reported findings, walking back their bold claims, and their hesitance to admit they were wrong [1:17:45];</li> <li>Brain benefits of HRT, Alzheimer's disease in women, and estrogen as a preventative treatment for AD [1:22:45];</li> <li>The impact of HRT on heart disease, the ideal time to start HRT, and the risks associated with HRT [1:26:45];</li> <li>The benefits of estrogen on bone health, and the incidence and mortality of hip fractures [1:33:15];</li> <li>Colon cancer: Can HRT reduce the risk of colon cancer? [1:38:15];</li> <li>Diabetes: Can HRT reduce the risk of developing diabetes? [1:40:30];</li> <li>The downsides of hormone replacement therapy (HRT) [1:41:30];</li> <li>How to approach your doctor who may already have a very strong point of view about HRT [1:42:15];</li> <li>What kind of research needs to be done to answer the remaining questions about the benefits and risks of HRT? [1:48:30];</li> <li>Cancer: Our evolving understanding and the future of treatment [1:59:15];</li> <li>Welcoming the critics: Avrum and Carol want to start a conversation [2:02:00];</li> <li>Are there racial differences in benefits and risks with HRT? [2:04:15];</li> <li>The reactions to Estrogen Matters, and why it is a must read [2:09:15];</li> <li>HRT after a diagnosis of breast cancer [2:13:45]; and</li> <li>More.</li> </ul> <p> <span> Learn more at <a href="http://www.peterattiamd.com/"><span><u>www.PeterAttiaMD.com</u></span></a></span></p> <p> <span>Connect with Peter on <a href=""> <span> <u>Facebook</u></span></a> | <a href=""> <span> <u>Twitter</u></span></a> | <a href=""> <span> <u>Instagram</u></span></a>.</span></p> </div>
Actionable Insights
1. Consider HRT for Longevity & Quality of Life
The overall benefits of hormone replacement therapy (HRT) for most women, including reducing risks of heart disease, Alzheimer’s, and osteoporosis, generally outweigh the downsides. Women should at least be offered HRT for consideration to live longer and better.
2. Re-evaluate Midlife Symptoms
Many symptoms in midlife, such as depression, muscle pain, cognitive decline, sleep disturbances, joint pains, and palpitations, may stem from the dramatic drop in estrogen during menopause, rather than other causes like a ‘midlife crisis’.
3. Challenge Estrogen-Breast Cancer Link
The widespread belief that estrogen causes breast cancer is an embedded assumption not fully supported by evidence; in fact, women diagnosed with breast cancer while on HRT often have a better prognosis.
4. Prioritize Heart Disease Risk in Women
Heart disease is a greater killer of women than breast cancer in every decade of life, with a 7x lifetime difference in mortality. Be aware of atypical heart attack presentations in women, such as an upset stomach.
5. Understand HRT Timing for Cardiovascular Health
If you have pre-existing cardiovascular disease, do not initiate HRT. The ideal time to start HRT is around menopause, within the first 10 years of cessation of periods, as this window shows no increased cardiovascular risk for women without pre-existing disease.
6. Estrogen for Alzheimer’s Prevention
Estrogen is a potential preventive medication for Alzheimer’s disease, capable of reducing its incidence by 20-50%, while common interventions like diet and exercise have not been shown to prevent it.
7. Estrogen for Bone Health
Estrogen can decrease the risk of osteoporotic hip fracture by up to 50%, outperforming other long-term treatments. Calcium and Vitamin D alone offer no protective effect against hip fracture in post-menopausal women not on estrogen.
Empower yourself by reading comprehensive resources like ‘Estrogen Matters’ to understand the data, allowing you and your physician to collaboratively determine the best HRT program for your individual needs.
9. Caution with Compounded ‘Bioidentical’ Hormones
Be wary of ‘bioidentical’ hormones prepared by compounding pharmacists due to potential lack of quality control and clear dose equivalency; pharmaceutically prescribed estrogens like Premarin have extensive supporting data.
10. Micronized Progesterone for HRT
If progesterone is required as part of HRT, micronized bioidentical progesterone appears to be the safest form of administration.
11. HRT for Breast Cancer Survivors
For women with a history of successfully treated breast cancer, HRT is an open question, not an automatic contraindication, with multiple studies showing no increased risk of recurrence. This decision requires careful discussion with a physician.
12. Challenge ‘Natural’ Arguments for Health
Question the notion that interventions like HRT are ‘unnatural,’ especially when considering living a longer, healthier life beyond reproductive years.
13. Avoid Extremes in Medicalizing Problems
While over-medicalizing problems should be avoided, equally important is not to under-medicalize legitimate health issues, finding a balanced approach to care.
14. Practice Critical Thinking
Be aware of cognitive biases like confirmation bias and negativity bias when evaluating health information. Do not accept claims of ‘almost statistical significance’ as valid findings.
15. Read ‘Estrogen Matters’ Book
Read the book ‘Estrogen Matters’ to gain a deep, data-driven understanding of hormone replacement therapy, and follow up on its references to verify information for yourself.
16. Read ‘Mistakes Were Made (But Not by Me)’
Read Carol Tavris’s book ‘Mistakes Were Made (But Not by Me)’ to understand why people resist new, beneficial information and the barriers to critical thinking.
17. Review Podcast Show Notes
Check the podcast show notes for visual aids, such as images illustrating the female hormone cycle and charts comparing cardiovascular disease and breast cancer mortality risks, to enhance understanding.
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