Perimenopause and Menopause Myths Busted: What Every Woman Should Know About Hormones

There's a lot of truths and a lot of myths circulating around about hormone replacement therapy. Whether it's safe or not, how old you are when you start therapy, how young you should be, and even when you need to stop it or not stop it. Today's episode is a Q and A with myself and Kelly Rezendez. And we're gonna go through some of the biggest myths that you need to understand as you look at your perimenopause, menopause, and even post menopause journey.

So we're digging into the truth about bioidentical hormones. So let' start at the very top. What is the difference between bioidentical hormones, synthetic hormones, and then not having hormone replacement therapy?

Yeah, yeah. So let's, let's get the word bioidentical out of the way because there's a lot of misinformation. Some people say it's a marketing term, some people say it isn't. So here's what it is, right? So your body produces a hormone. We'll call it estrogen, right? Or estradiol. Imagine that this estradiol is a key. So that key has five fingers on it. So when we look at the chemistry of it, it has these five fingers. When it's bioidentical, it's like you took that key to Lowe's and they made a copy. It's the exact same copy, exact same number of fingers on it. So when it gets to the cell and it goes to click in and turn on the action at the cell, it's able to do that, no questions asked. So it's chemically identical. It is synthesized in a lab, but chemically identical to what you make. Now, there's some very important pharmaceutical caveats to this. Bioidentical items, things that can be found in nature, cannot be patented. So it is not a moneymaker for a pharmaceutical to make because they can't keep other people from making it, right? So if you're on a bioidentical hormone, whether it's testosterone or progesterone or. Or estrogen, or even your thyroid, it is chemically identical to what you make synthetic hormones, right? So the most common are your birth control pills, your Mirena IUDs, or other IUDs, things like progestogens or medroxyprogestin, which is a synthetic form of. Of progesterone, but is not the same. So imagine that key, it's now missing a finger, right? You kind of get in the clock, you know, like, have you ever had a key that kind of didn't work and you sort of jimmy it and you can kind of get the lock open. It's. That's how it works. It kind of can fit it, but it's not exactly the same. The reason why this is important is your body knows how operate with normal bioidentical things. It's going to have the exact same chemical structure, it's going to do the exact same function. When something is synthetic, it has similar action, but it's not quite the same. And probably where it becomes even more important is when you take these drugs in that are synthetic and you, number one, take them in and digest them, they go to the liver and they have to process through the liver. And depending on your genetics, you process them better or worse. And when they get processed, they make a bunch of byproducts. Those byproducts can either be harmful, toxic, or moderately, you know, okay. And so many of them have negative side effects. So, for instance, synthetic medroxyprogestin is associated with blood clotting risk in women, particularly as we get older. But if you have a clotting disorder that you probably may not know about, it can even be damaging as a teenager in a birth control pill. The other thing I want to kind of clarify this too, is your birth control things like birth control pills are synthetic. And what they do is they bind to that receptor. So think about hitting the key and they irreversibly hold onto it, right? So if you're on a birth control pill, they hold onto that receptor and never let go, which is why you don't ovulate, right? So it does that in the ovaries. You can't ovulate. It keeps you from getting pregnant. Ioanatical hormones don't do that. They go in, they do their thing, they let go, and then they go away and they go to the liver and get cleaned up. Right? And so that's, that's the difference between synthetic bioidentical. And then I want to make one caveat to that. There is an older estrogen product called Premarin. And Premarin is made from pregnant horse mare urine. It is literally extracted from pregnant horse marine urine and has 13 estrogens. We make three. So all of that is going to go to the liver first, make a bunch of byproducts that increase clotting risk in older women. But it kind of burdens the liver. And so all of those synthetic forms, or the what they call conjugated equine estrogen or horse bee, and then Synthetic hormones you don't want because your body isn't going to use them the same way. And then menopause is a time period of hormone extinguishing. Basically, ovarian function stops, so those hormones are no longer being made. Right. And so when you're not on hormones at all, all the keyholes in all the cells of your body that are prepared to take estrogen or progesterone or even testosterone, and that's now very, very low, don't get fed. And so the act of aging goes up. Right, got it.

And so women have a choice now, and there's been a lot of changes that have happened over time. What would you say the best decision, in your opinion is for a woman that's considering hormone replacement therapy?

Yeah. So if we look at their research. So I'm a PhD, so this is beautiful because I get to dig through the literature every day. So the reality is the research is pretty clear that hormone replacement therapy started earlier in the process. So we don't have to wait until we're, you know, out years after the period started in the process. Reduces all risks of dying. Right, all risks of dying, but particularly reduces cardiovascular disease risk, osteoporosis risk, and dementia in women. And so for a woman, what I believe, and regardless of age, is every woman deserves the right to examine hormone replacement for them. Of course, if you're looking at it, that earlier window is better. So within that first 10 years, because we age more rapidly when we don't do it. But the other side of it is, is I also see in the industry people that are sort of, you know, gaslighting or even sort of being on the attack for women that may choose personally to not choose hormones. And there's definitely, there's definitely an opportunity for that too. I just believe every woman deserves the right to explain, explore that for themselves without judgment, without gaslighting and with education. And so. Yeah, and so I think it's real important.

So there are so many, you know, I would say untruths or myths out there about em, and we're talking about the truth about hormones. What would you say the top ones are?

I would say the top myth is that you can't do hormones at all. Right. That hormones cause breast cancer. Let's start with the first one, the one that was kind of overblown from the Women's Health Initiative that. So we. First thing is we started using hormones in 1942. Right. Estrogen replacement therapy started in 1942. And by the time you got to the 80s and 90s, you know, millions of women worldwide were put on hormones as standard of care. And at one point we were prescribing as many hormones for women in perimenopause and menopause as we were statin drugs. Right. So about those numbers. So, and it was one study, the Women's Health Initiative, where they narrow represented some of the data. So essentially the women that were on no hormones at all, that they examined in the group that had no hormones at all, the risk that they saw was, was three out of a thousand women had a risk for breast cancer. Right. In the group that were on a product called Prempro, which no one should ever use. Synthetic medroxyprogestin increases clotting risk in women. We would never use that today. But that's the arm that was using that drug. It went to 4 in 1000. Not statistically significant. Could have easily been to chance. But what they put out to the media was that it was a 26 or 23% increased risk of breast cancer. And the media and the medical community went wild. And so therefore then the black box warning and every woman was taken off of hormones. And so we were told for decades that you get breast cancer. And that's not true. The reality is no study prior to that showed increased risk and actually even reoccurrence of breast cancer doesn't show increased risk with hormone use. And actually high dose estrogen was used as treatment for estrogen sensitive cancer until the kind of chemotherapy drugs came out in the 80s. Right. So we would have used estrogen to treat an estrogen sensitive cancer prior to that. Now we've gotten better at it and all those other things, but it's really not true. And so I would say that's the biggest risk or that you had family history, that you can't have it. That's not true. If you have BRCA gene, that's not true because the BRCA gene is a gene that cleans up things that like broken DNA strands, right. Has nothing to do with your estrogen. So the reality is, is that that doesn't correlate. Right. One of the other major myths is that you only do it at the shortest dose, the shortest amount of time to get rid of hot flashes only, and then you stop. Well, that's not true because we know it reduces your risk for all causes of dying and things from dementia, like dementia reduces your risk for 50%. As soon as you stop it, those values go away. Right. The longer you're on it, the more protective, particularly when you look at osteoporosis research, and then we also have this kind of myth, but there's some reality to it too. So I have to be really honest, is the ten year window that you can't have hormones if you went through menopause either naturally or surgically ten years ago. Right. Here's what we do know is, particularly from the cognitive studies is when a woman starts hormone replacement therapy before that sort of acceleration of aging, we don't see the brain age as quickly. We hold on to gray matter and white matter. We don't change the blood flow and the energy production in the prefrontal cortex. That important part up here, the bone loss isn't as great. Right. And so, and then the arteries don't age as quickly. But when, but when you've gone through 10 years or 15 years, some of that's already occurred. That's naturally occurring as part of the aging process. So we don't get as much protection. But it doesn't mean you can't do hormones. It just means we're not going to have as great outcomes in those areas. What I will say is osteoporosis has good research with hormone replacement therapy even in much older women, starting it much later. Right. It has good indication because it helps with bone building, even in men.

Wow, that's amazing. So it sounds like the truth is that hormone replacement therapy in bioidentical is going to help improve the quality of your life and how long you live. Yes, absolutely amazing. So digging into, you know, I would say another area here that we don't hear often about. And I think we need to is really hormone metabolism, like share a little bit about what that means. Because I think most of us just think about is my estrogen high or low, Is my testosterone high or low progesterone? Same thing. What is the truth about what hormone metabolism is and how important it is to us?

Yeah. So your hormones obviously get made by the particular organs where they get made. So your hormone levels are about what you make, what you potentially take, and then how you get rid of it. Right. So everything in your body sends byproducts to the liver. So think of the liver as this huge like cleansing organ. Right. It it biotransforms it or detoxifies it. Hormones have particular pathways that they go through. So I'm gonna give you a house analogy. So when you go to clean up your house, you have to kind of go in order. Right. So if you're going to clean out your attics, you got to clean out your attics. Right. You don't want to clean out your attic. And then your garage is full because you can't get it to the dumpster outside the garage. So when we look at hormones, hormones are like cleaning out the attic, cleaning out the closets, cleaning out the garage, and can I get it to the dumpster? What we know today after the Human Genome Project is that some of us are really good at getting stuff to the dumpster and getting the right closets in the right order. Right. Some of us aren't. And so when you look at hormone metabolism, we're looking at that process of cleaning out the house all the way to the dumpster. And so we can see what's your total body burden for those hormones. Now this is where it's really important because if we look at like so breast cancer, the average age of diagnosis in United States is 62. So a good decade after menopause. Right. On average, a woman goes through it at 51. Our risk is greater when we don't have our natural hormones. Kind of interesting, huh? So what it means too, this is an area of a lot of research. We have pesticides, herbicides, plasticizers, fragrances, parabens, all these things that are in our environment that are estrogen, like they go through the same pathway. And so those things can be mucking up that pathway. Those things could be impeding your own hormones, getting metabolized while you're still cycling. Or they could be occupying those receptors, those, those keyholes because your hormones aren't there. Right. And so when we look at hormone metabolism, we're looking at like the free levels and how many you have and then how are you getting them to the dumpster? Because this is a place where diet, nutrition and supplementation can have a huge impact. We can literally say move it to the really clean pathway and get it to the dumpster super quickly. Or we can eat really bad and do bad things and it stays in the house and keeps loading up until you're order.

Yeah, definitely. Well, and I just don't think we think about those things. You know, we, we don't have these conversations and unless you've somebody. So what would you say, like what is really the difference between symptom management and long term longevity? You know, I think that we, we know people like the get get rich quick theme. They like the microwave results. Like tell us a little bit about how hormone replacement therapy impacts those two things.

Yeah. So I'm going to give you a patient story because I think it's really important. So we had a woman come to us who was about 62 years old. She went through menopause kind of late, which actually is somewhat protective. She went through menopause, had a DEXA scan, so had her bones looked at, had good bone density, and she went to, saw a doctor that was well meaning. Put her on hormone replacement therapy and actual bioidentical hormones. She lifted weights, she ate protein, she felt pretty good. No hot flashes, no night sweats, wasn't angry, didn't want to like strangle anybody and, you know, was put on a dose and was kind of like, here you go. And they look at stuff, but they never really checked, they didn't check hormone metabolism, they didn't really look at the blood work to see, see where they were compared to the protective ranges that we're looking at. So when she came to us, we looked at an Echolite, which is another deeper dive sort of in the bones, right. And also Adexa. And she had lost bone. She was actually now osteoporotic. Right. She'd been lifting weights, eating protein, on hormone replacement therapy. All of which should have stopped that from happening. Well, when we started looking and we look at her blood work, her, her estradiol level was like 32, right? Not symptomatic, felt fine. But 32 isn't in the range where we start to see major protection to the bone. So she had been going for almost eight years without enough hormone because they were using symptoms as the primary driver of whether it was adequate or not. Louise Newsom's group out of the uk, she's heading up the entire UK menopause strategy for the entire medical system. She has a clinic there and she did a study and the UK has a single dose. They're like, this is the dose that you get. You don't get more, you don't. They don't, you know, they're like, this is it. And so when she was looking at her population, so of the a hundred percent that took the hormone, 50% were under treated, meaning they weren't protecting the bones. 25% were over treated. They were getting symptomatic because of too much. How we absorb those hormones, how our body uses them, is individual. So if you are not testing, you do not know and you can't use symptoms as a primary driver. I have never had a. I had so many symptoms at perimenopause. I couldn't sleep, my hair was falling out. I gained 35 pounds. I couldn't lose for a decade hot flashes and night sweats. Were never one. I've never had either one of those. I'm still cold. I'm wearing a sweater and a blazer. In Texas, it's so we can't use symptoms as a primary driver. And too many times, that's what practitioners use. And they're like, you're cool, let's go. And you could be. You could be creating a situation where you don't know. You're not protecting yourself. And that's. That's the second step of what we're looking at. I want you to feel awesome and rock your world, but we also want you to protect yourself and be at the best possible health. Right?

Yeah. So let's talk about blood ranges and the truth about them. Anyone that's listening has probably been to a western medicine doctor, may or may not have gotten their thyroid, their hormones, other things tested there. How does that differ from integrative and functional ranges that are out there?

Yeah. So the first thing, when you look at a lab and you look at the reference ranges, so the lab took the averages of the people that come in to get a lab work, and then they just go, okay, what's the standard deviation? Hate those math terms. Right. So what's the midpoint to this end? To this end, this is our ranges. I don't know about you, but if you look around, 75% of the American population are overweight or obese. That means we're not healthy. Right. So none of those are healthy ranges, number one. And healthy ranges for hormones are not at 55 ever. Right. Because we weren't designed to live this long. You know, as. As recent as 1900, our lifespan was 48 years, if you count also how many of us died during childbirth. Right. But then, even if you move it forward, we didn't make it much past 60. And so if you took those numbers out. Right. So we didn't live decades after menopause. So the healthy span ranges are going to be an average of a woman in their 30s. Right. And so when we're looking at reference ranges, we're looking at them from a functional standpoint in a much narrower realm. And when we're looking at particularly sex hormones in these narrower premenopausal numbers. Right. Now, what's interesting is we look at the literature for, like, protecting particularly the bones and the heart and the brain. We don't need huge numbers. We actually replace a very small amount. We just need to get to about 10% of what you made of when you ovulated for estrogen, for example. So we look at blood levels to see where they are compared to what we've researched. Then we check urine to see how much you've got that's actually active and how do you get rid of it? Right. It's two pronged approach. Yeah.

And so are there just reference wise, just some loose numbers that you can say, like here's where on average we see estrogen protecting you, where we see testosterone and progesterone.

Yeah. If we look at these. So I'm going to give the low end ranges and kind of where somebody might be in perimenopause or, you know, and then, and then, you know, what's kind of a long term thing. So if we look at the estradiol. So estradiol is the single estrogen that we really wanna look at. Right. For like bone protection. We start to see bone protection in like the 50 to 80 range. On a blood lab, right. When you ovulated, it was almost 500 months. So it's tiny compared to what you made now in a lot of women. To get all of the improvements that we wanna see, particularly earlier in life, we get it to about 100, 120 in a lot of cases. Right. There are, you know, there are reasons to maybe go below or higher. Like if somebody had, let's say fibroids, we have to adjust. Right. Um, but that, those are general numbers. But we know we get bone protection at very, very low levels. I think that's really important. Estrone needs to be at a minimum 10% of that, but in many cases much more. Right. If we're looking in blood work, so if your estrogen's in 80 and you're estradiol, you need at least an eight. And I would say some people may need to be closer to 16 to 20 something to get into the ranges where we see improvement in sleep. Testosterone. Right. The FDA hasn't approved testosterone as a drug. So for women, except for sexual dysphoric disorder, meaning you don't want to have sex. And so we don't have a lot of good literature here, like from the fda, but we have a ton of literature showing that it's helpful. And so the ranges we're really shooting for is, you know, somewhere in the 80 range, there are some women that feel much better in the like 100, 150. When you start pushing past that, you can start having a lot of sexual side effects. So there are companies out there that push higher levels, but you can get things like hair loss, chin hair growth, clitoral enlargement. Which is exactly what it sounds like. You don't want that because that won't necessarily, necessarily go away. So it's important to have that dialed in and controlled right at the right level. And then when you're looking at thyroid and all those other things, those ranges are much narrower.

Yeah, got it. What would you say for the woman that's out there listening, like, how do I, you know, how do I really explore what's best for me?

Yeah. So I think this is why we created Minerva is. I think so many people or so many women really have questions. They. And they don't know who to turn to. And so in many cases, the doctor that took care of you for 20 years and delivered your babies don't really know what they're doing because they came up and were in residency when we took women off hormones. So they literally weren't trained. And so I think it's really important to have a trained clinician who understands not only how to replace hormones effectively, how to treat with bioidentical hormones, and understand each woman's a little bit unique, how to read the reference ranges and understand your unique needs and also how you metabolize it. But I think even more importantly, you've got to have a practitioner. And we have a team. We have a health coach, we have a nutritionist, but a team that's there to listen to you, because there's a lot more going on than just, my hormones are out of whack. Usually at this point, we got too much on our plate. Life is difficult. I don't know about you, but I'm like, man, I don't want to cook. You know what I mean? Like, most people are like, no, everybody left the home. I'm finally free. So, you know, there's so much that goes on that I think it's important that your medical provider has a very strong understanding of that and can actually have those conversations and that you have a team that works with you, that helps you with all parts of it. This should be our most awesome time period.

I love it. Final, final. Here is. You know, we women are such connectors, right? And so we talk to one another about our experience. And I've come across a lot of women that are like, I'm not going to do it because they've heard. Heard somebody's had a bad experience. And to be honest with you, I recently went through some adjustments where I believe my progesterone got too high. Right. But if I shared that with somebody, they may decide not to go on it. Talk a little bit to that person. That's like, I don't want to do it because I've heard that this happened or that happened, because a lot of times we might have a personal experience, but we didn't get that right amount.

Right, right. And. And that's true. So, you know, here's the thing is, right, whenever. Whenever, you know, our clinicians are on videos or we're meeting with people or having, you know, large group conversations, someone always throws their hand up and go, what dose should I be on? And number one, you can never do that in a group because it's not ethical. But the reality is, is what works for your best friend, you could be the same height, roughly the same weight, maybe a completely different dose than what your body needs because you absorb it differently, you metabolize it differently, your body's different. Like, two women could be standing next to each other. One of them could have been like, I have endometriosis and fibroids and hell on earth. The other one's like, I didn't even know I was having a period. Right. There's so much variability there. So what happens to one woman won't happen to you. And I would say this. This is why Minerva exists. We don't have enough research out there to really understand how to individualize to women. And so we are building the platform to actually allow that positive, predictive and preventative sort of thing for each woman individually. But the reality is we have to start at a lower dose. We have to use your symptoms and other things that we can pick up either through your wearable or how you're feeling, to slowly move that, which we call titration. And then when we're feeling really good, then we check labs, we look at blood work, and go, okay, where are we? Are we in those ranges where we know we've got protection? And then after that, we look at how you metabolize. So you're getting it to the dumpster after all of that. We usually have stuff pretty well dialed in, but for a lot of women, they start to feel better immediately. So sometimes it's like a matter of weeks. They're like, oh, my God, I feel like a different person. But the dialing in is somewhere between three and six months, right? And so once it's dialed in often, and then, you know, if we're working on weight loss that, you know, all those things start working. But what happened to your friend and how they were treated and what happened is not going to be what happens to you because you're all uniquely individual.

Well, thank you so much, Dr. Betty. And that's it. The truth about Bioidentical hormones. Great information here. Definitely. Check out Minerva. Click on the links below. We'd be happy to share how we can help you get hormonally balanced.

And that's a wrap for today's episode of Menopause Mastery. If this conversation helped you feel more informed, more hopeful, more in control of what's happening in your body, do me a quick favor. If you're watching this on YouTube, hit subscribe and tap on the notification bell so that you don't miss the next episode. We're bringing you real science, real solutions, and real conversations every week. And if you're ready to go from guessing to getting a plan that is tailored to your health, head over to gethormonesnow.com to explore precision bioidentical hormone treatment through a functional medicine lens. Available in all 50 states for women. Because you deserve the care that actually connects the dots. Your hormones, your metabolism, your sleep, your mood, your brain, your heart, your bones. All. All of it. Thank you for spending this time with me. I'm Dr. Betty Murray, and I'll see you next time on Menopause Mastery.