5: The Truth About Estrogen and Breast Cancer with Dr. Tabatha Barber

Hello and welcome to the Kenya breasts podcast with Dr. Jen. The show dedicated to empowering women through knowledge, tools and resources to take control of your breast health journey. I'm your host, Dr. Jen Simmons, and I'm thrilled to have you join me on this insightful and inspiring journey. As a breast cancer surgeon turned functional medicine physician, I'm on a mission to empower women to live their breast I need best lives. This podcast dives deep into all topics related to breast health, including prevention, diagnosis, treatment, and holistic approaches to support overall well being. You know what I say? Breast health is health. So no matter who you are, a breast cancer survivor, newly diagnosed in treatment, living with metastatic disease, or you're simply seeking to improve your breast health, this podcast is for you. Join us on this transformative path towards better breast health and a thriving life. And now, let's get to today's episode. Hi, it's Dr. Jen, and welcome back to another episode of keeping your breasts with Dr. Jen. I have a really special treat for you today, and I know that the conversation today is going to resonate with every single woman who is in that stage of her life where she's transitioning from babies and being reproductive to maintaining your importance, your function, exercise, everything on the second half. So today we have the very fabulous Dr. Tabitha Barber. Dr. Tabitha is triple board certified. And you actually have a story that is similar to mine in that you spent the very first part of your career deeply steeped in what we call conventional medicine. I'm not going to call it traditional medicine because we know very well that what we practice now is traditional medicine and what is generally understood as medicine is conventional medicine. And you actually went on a different path. And I think what you said to me earlier really, really resonated with me in that we think of gynecologists as hormone specialists. Right. But actually, what you said is that gynecologists are surgeons and not hormone experts, and we are looking to our gynecologists to answer our hormone questions. And there are a lot, and we're going to get to them today. So, Dr. Tabitha, welcome.

Oh, my gosh, I'm so excited to be here. Yes. I am a fellow surgeon just like you. And you know full well when you're a surgeon, that's what you live and breathe and you want to do surgery. It's very rewarding. It's an amazing gift to be able to do that, you know, those procedures. But I didn't get the training in hormones that everybody thinks obgyns have. You Know, we don't get much beyond.

And you're not. You're not the exception? No one?

No. This is like the standard training for an OB gyn. We spend four years delivering babies, doing crash C sections, episiotomy repairs, all of the procedures that are necessary, and emergency situation, you know, we're like the emergency doctor for down there. Yeah. And the training I received for hormones was very basic, very minimum. And this is the standard across the country for OBGYNs. I remember having a conversation with one of my attending trainers saying, well, how do I know which birth control to pick for each problem that we're treating? Because we use birth control for every symptom. And he literally said to me, you just try some, and if they don't like it, you try a different one. It's like a game of roulette. There's no rhyme or reason. There's no science behind any of it. We're just throwing spaghetti at the wall and hope it sticks. Right? Yeah.

So it's amazing, though, because we. We do, as a society, assume that OB GYNs are trained in hormones, and they are who everyone goes to with hormonal problems. And I heard you say that when you try to solve people's hormonal problems with either giving them more hormones or on the opposite end of things, giving a hysterectomy to someone, then you're just complicating the picture even more.

Exactly. I mean, we really are practicing very archaic medicine when it comes to women. You know, we are doing the same things we were doing in the 40s and 50s. Things have not evolved, unfortunately. Like, if we think that you're acting hysterical, we give you a hysterectomy to remove your. Your organs so that your hormones can calm down. Or we give you the birth control pill to shut down your own hormone production. And that's a really big myth out there, is that birth control pills regulate our hormones. Like, I found myself saying that as a gynecologist, and I almost bought into that idea after a while because that's just what you say to patients to make them feel okay with taking the pill. It's like, oh, we're just going to regulate your period. But that's not actually what's happening. What's happening is when you take these synthetic hormones, birth control pills, IUDs, depo shots, the mini pill, they are stopping the communication between your brain and your ovaries. Your ovaries stop making their own hormones, so it's overriding your system. It's Shutting your system down. And now what we're seeing is women on birth control pills for decades, 10, 20 years. They're waiting longer to have children. They try to come off of these pills and they don't have their own periods. They don't have a cycle or it's. It's an absolute mess. It's super irregular. And they can't get pregnant because we didn't actually regulate their hormones. We shut them down.

Yeah.

Point blank.

Yeah.

You know, so I would love for.

You to first share your background. How did you arrive at this place with all the wisdom and insight that you have today?

Well, my.

Because I know, I know you didn't get it from the doctor who told you to throw spaghetti at the wall.

Right? Exactly. My whole life, I've kind of been an outcast. I went against authority. I lived in detention when I was younger, and I'm actually a high school dropout. I got pregnant in 11th grade, and I dropped out of school to have my daughter. And so my path has always been winding and never straight and never made a lot of sense to anybody. And I just had God, like, calling me forward to do things. But I had a very traumatic pregnancy and delivery. I developed Hashimoto's thyroid disease. And I went on to have my thyroid burnt out with a radioactive iodine procedure that no one discussed with me, no one talked to me about. It was just kind of done to me, and I didn't understand it for probably two decades. What happened? And so all of these things shape you who you are. Right? So I got this grandiose idea that I'm going to just be the doctor myself and I'm going to give women a voice and a choice so they have better options. And 10, 15 years later, here I am in the broken system, and I had lost myself. I had lost that individuality and my ability to ask why into question and all the things that got me in trouble as a younger person. And it wasn't until I was having major health issues myself that my eyes were really opened. I, you know, I was delivering babies all night, doing surgeries all day, cranking out 40 patients, you know, in an afternoon. And I was exhausted. I couldn't remember the people I delivered the night before. I had terrible irritable bowel syndrome, like, it ran my life. I was addicted to sugar and coffee. That's how I survived. And one day, I couldn't walk away from the C section table. I was done with the surgery, and my back hurt so bad, I literally couldn't move my leg forward, and I just had to bend over and lay there for about five minutes. And, you know, the nurses and everybody else were like, are you okay? Are you okay? And I had been ignoring this back pain and just pushing through with my life because it's the right thing to do to take care of everybody else and ignore myself. That I got to my breaking point and I finally broke down and went and saw the orthopedic surgeon. I was like, okay, let's figure this out. He said, oh, yeah, you just need surgery. We're just going to do a quick, you know, you. You herniated, ruptured your desk. We're going to do surgery. You're going to take six weeks off and you'll be good. That seemed like the end of the world to me, honestly, taking six weeks off. Who's going to take care of my patients? My children? But I did it. And on the third night, I went back on call. I re injured my back and I couldn't move. The surgeon literally said to me, oh, back surgery is like lay's potato chips. You can't have just one. We're just going to put rods and screws in there. You might herniate above and below, and you might need a further procedure. And it was like the biggest awakening moment of my life. Time out. I'm not doing this anymore. There's absolutely no way you're doing that to me. And I laughed. I took four months off of work and I found the world of functional medicine. I said, there has to be something I'm doing that's causing this pain in such a young age. And lo and behold, it was. It was my sleep deprivation, my crazy stressed lifestyle, my terrible diet, the fact that I was ignoring the relationship with my husband that was broken, like all the things. Things, right?

Yeah.

It was all this weight carrying on my back. It broke my back. And once your eyes are open, you can't go back, right? Like, I all of a sudden learned about leaky gut and how that controls everything and why I had IBS for 20 years and Hashimoto's. And so I tried to do that as a gynecologist. I tried to go back and do functional medicine with my gynecology patients and.

That go.

So you know this. When you are owned by a hospital system, you go to monthly meetings and they give you the reports and they tell you you need to see more patients, you need to do more surgeries, you need to make more money. Don't know how I could possibly do that, but that's what I hear every month. And so it lasted about three months. They let me see patients on Fridays. I billed for time. And then they were like, nope, we're LOS money. You can't do this anymore. You have to go back to the 15 minute appointments. And that's when I made like one of the hardest decisions of my life. Like, I need to walk away. And I was chief of staff. I had been chief of the OB department for years. Like, this was my home. This is what I knew. My patients loved me, but I knew it was no longer the right answer. And that was really hard. And so I just encourage women, like, if you are feeling like you're in the wrong situation, you have to be brave. I gave up the salary, I gave up the 401k. I gave up all that stability because I knew it was the right thing to do. Because I wasn't actually healing women by giving them birth control pills and doing their endometriosis surgery every six to 12 months. They needed functional medicine. And I'm like so grateful. I never look back for people that.

Still don't exactly understand what that means. Can you just talk about the nuances between functional gynecology and what we understand, you know, usual conventional gynecology to be.

So conventional medicine is very much focused on giving you a diagnosis of some disease or some condition and managing those symptoms. So you have 15 minutes to go in and say, day, my period is heavy and I'm moody and I got to come up with a solution. You need to walk out of the door with a plan that's going to get rid of that symptom tomorrow. And so we're, it's, I call it band aid medicine because we're just trying to cover up the symptoms so that you feel better for the moment to continue pushing through on your life like I did. Functional medicine is saying, why are you having these symptoms? Those are actually messages from your body. Your body's trying to tell you that something's out of balance, something is wrong. So let's do a little research and figure out why you are having these symptoms. And so we call it root cause medicine because we're trying to figure out where is it coming from? You know, it's not the symptom that's the problem. The heavy periods are not because your uterus hates you or your uterus is bad and it needs to come out. But that's the mentality, like, remove the offending organ, right? Yeah. Instead we gotta think, why is your uterus overgrowing the Endometrial lining. Why is it bleeding so much? It's because your hormones are not balanced. You're making too much estrogen. You're not making enough progesterone. Something is out of alignment and even further back from the hormone imbalance. What's driving the hormone imbalance? And I promise you, women are very surprised when we talk about the root causes of hormone imbalances. I know. I was surprised the first time I sat in a functional medicine lecture, you know, through Cleveland Clinic, and I was like, wow, I knew all this. First year of medical school, and then you throw it out the window.

You do.

You walk into the hospital.

So true that we do learn all of this our first year of medical school, but then later on, we are literally taught to disconnect from that. Yes, Literally taught. Stop thinking about the why. It's by intention. Obviously. We are trained because who formats our curriculum? The pharmaceutical companies, the device companies, the people that support the medical schools. That's what we learn. We learn those band aid techniques. We are literally taught band aid medicine.

I don't think people realize that drug reps and equipment reps, they come and they bring us lunch two to three times every week during medical school, during residency. That is how you get trained and you learn how to treat someone. The rep comes in and says, here's the new drug. This is the symptoms that it's for. Give it a try. Here's the new ablative technique that we have. Try my equipment. We'll bring it to you for free. And they come into the OR with you and they push this stuff on you, and you think you're helping women and you're doing the right thing, so you don't even question it, because it is what it is.

Yeah, it's true. So let's get into demystifying hormones, because I think that that is probably one of the most confusing areas. I specifically want to talk about menopause, because we have been trained to think that menopause is just something that people need to endure. Hormone testing in the conventional medical world is essentially unheard of. Unless you're going for a fertility workup.

Yes.

And so why do you think that so many gynecologists are ill equipped to handle the issues associated with hormone imbalance?

It's not part of our training. It just really is not. You are correct that I was taught how to order some blood labs for fertility issues to see if someone is ovulating, to see. To make sure they're not in premature menopause so that they can go to the reproductive endocrinologist and receive ivf. Like, are you a candidate to get high dose of hormone injections to stimulate ovulation? It was never taught to us. Like this is the ratios that you should have throughout the month of your estrogen and progesterone and here's how testosterone affects the whole picture. And like that kind of stuff is just not being taught. And because it's not necessary, gynecologists are getting away with doing what they're doing. So there's no research on, on this. You know, the research is now showing up more and more in the menopausal and perimenopausal situation where we're starting to understand that transition period of your hormones are no longer being produced at reproductive levels to, you know, obtain and carry a pregnancy. Now they're going through this transition, but it's still not being welcomed in the conventional medical space, in the alternative space, functional medicine, integrative medicine, anti aging medicine. The studies are endless and we are all over that and we are learning so much and we really do understand hormones. But I had to leave the world of conventional medicine and go study way beyond that with all of these other programs and institutions to learn this. I didn't learn it as an ob gyn and it's heartbreaking to me.

And do you think in the premenopausal population, the reason that there's no studies and the reason that there's no work around, really, I don't want to say balancing people's hormones, but helping them to figure out why their system isn't working? Because we are all perfect beings and our bodies know how to function. And it's the things that are in and on and around us that are disrupting how our body's functioning. Right. It's the environment that we're creating that is interfering with that function. Do you think that there are no studies there because it would kind of get rid of the whole practice of fertility? Because essentially all that's happening there is that they're loading them with hormones, forcing follicle stimulation, taking out those eggs, fertilizing them, making embryos and reimplanting them. But they're not doing anything to alter why that person can't do that on their own.

Yeah. Oh, it's huge money, huge industry that's never going to go away. I do case reviews for a company out of Canada called Fabfertile where they try to help reverse premature ovarian insufficiency. And every single case that I Review. The woman has gone through multiple rounds of ivf, and by and large, I can never figure out why they jumped to that. But that's what they do. They don't try to figure out what your infertility issue actually is. I've seen women who didn't even have a basic hsg, which is a test to see if your tubes are open, like maybe your tube is just blocked and that's why the egg can't reach the uterus. Like, basic stuff, basic hormone levels not being drawn, jumping to IVF because it's such a money maker. And it's so heartbreaking for these women because they, like, it's a loss every time you go through that cycle and you don't end up pregnant. Like, I just feel like it's mental abuse actually, the way they treat these women. And you are absolutely correct. That's one of the big reasons that we're not trying to figure this out in conventional medicine. The other piece of it is there's really no drug that can come in and quote, unquote, fix it or, you know, make it balanced, so there's no money to be made. So that's another reason studies are usually done, because there's a plan or a purpose of we're going to make this drug and then we're going to make this money off of this drug. That's why studies are done, by and large, because they're the ones that fund them.

So let's get into the peri and menopausal population. I came out of training in 2003, the same year that the Women's Health Initiative was released. And my training taught me that women who are really suffering should take the smallest amount of hormone replacement for the shortest amount of time. And for those that are not suffering, no one should be on hormone replacement except for those that are really suffering. So how do you respond to that?

Yeah, so before we came out into practice, it was common practice to give women hormone replacement therapy. And I was.

In fact, it was. It was the majority, majority standard of care.

Like you went into menopause, here's your Premarin or your Prempro, depending on if you have a uterus. And millions of women were on these hormones and they were living a pretty darn good life. Yes, they have a risk of blood clot and stroke if you have comorbidities and issues with them. But a lot of women were very happy on their hormone replacement therapy therapy in the 80s and the 90s up until this study that was halted abruptly and came out and got leaked to the media and like blew up the world and told us hormones were dangerous. So overnight, millions of women were taken off their hormones. Doctors panicked for fear of harming their patients and getting sued. They literally stopped prescribing. No, you cannot do that. It was a very knee jerk reaction. And unfortunately, 18 years later, the lead investigator of that study finally admitted that they went into that study with the intention to prove hormones were dangerous. They were biased, they had a plan from the get go. And as soon as they saw one extra breast cancer in the prempro group, they stopped the study and said it causes cancer and everybody panicked. Mind you, multiple studies prior to that showed absolutely no increased risk in cancer. The craziest part to me is that they ran with the story that it was estrogen causing the breast cancer. And it wasn't the estrogen alone arm of the study. It was the estrogen and progestin arm. It was the synthetic progestin that caused all the trouble in this study, which has many problems. First of all, the average age woman was 63. She was over a decade past menopause, so her body already didn't have hormones for a decade. The majority were obese smokers with cardiovascular disease. So they already had the comorbidities. They were very unhealthy going into the study. And then they had this tiny increase in blood clots, stroke, colon cancer and breast cancer. And the facts got so muddled and so twisted because the media, they can say whatever they want, right?

Yeah. There's no account. Well, and. And the media is after sensationalism. It's not exactly anything else they want.

Whatever's gonna sell the papers, whatever's gonna cause people to watch the news. So this was the biggest mess that, you know, have destroyed women because millions of women were absolutely miserable being taken off of those cold turkey. Yeah. I had the privilege of inheriting a very mature practice when I came out. So I replaced a gentleman who was 74 when he retired. So his patients were all postmenopausal. He had delivered their babies, seen them through everything. He had them on all of their Premarin and Prempro and he didn't take them off. So I inherited this population of women that I didn't know what to do with because I was trained. Hormone hormones were dangerous. And you do the lowest dose, shortest duration, only for hot flashes and night sweats. And here I have all of these women, you know, in their 60s and 70s and even 80s, telling me how hormones keep them alive and how they have sex with Their husband and how they exercise and play pickleball and their brains work and how their friends, like, are deteriorating in front of them, and they just, they don't ever want to give up their hormones. I remember one lady threatening me, don't you dare, like, ever try to prescribing me these. This is. Dr. Robertson gave me these. You're going to give me these. You know, and that was the mentality. And those women taught me so much. They really taught me not to fear hormones, that hormones make us who we are. And yes, synthetic hormones like conjugated equine estrogen and progestins, they're not the safest, but they're better than nothing. Because they are. They are.

I agree with you. Yes, we do. And I do want to say a couple other things about the Women's Health Initiative study, because I think that we were so misinformed, we just jumped on that there's an increase in breast cancer. But when you mentioned that the average woman in the study was 63 years old, many of the women in that study had previously been on hormones and then got assigned to the group because it was a randomized, controlled study, blinded study. So they got assigned to the group that wasn't taking hormones. Those women, because they had been on hormone replacement before, had a lower than expected incidence of breast cancer. So you're probably the results are false for a number of reasons. When you compare a group to the control and the control doesn't have the incidence of breast cancer as compared to the normal population, it can look like an elevation when it's really not. And that's what happened there. There were so many problems with that study, not the least of which is the study was actually the lead investigator was a cardiologist, and the study was allegedly designed to determine if hormone replacement was cardioprotective. Right. Protected against cardiac disease. But if that was true, why on earth would they have the average age be 10 years past menopause when we know that upon the cessation of hormones, you have a rapid deterioration in your heart health, in your brain health, in your bone health? And that's why it's so important to capture those women early. Because if you get to 10 years out, there's probably not a lot of benefit because the heart disease has already started to develop, the bones have deteriorated, the brain has deteriorated. And so it surprises me that there are still so many practitioners that are completely unaware. The word out there is, and I'm a breast cancer doctor, so I hear it all the time. Hormones Cause breast cancer. Estrogen causes breast cancer. Despite all of our evidence to the contrary, the estrogen alone group on that study, even though they were 10 years out, they still had a lower incidence of breast cancer.

I know it's mind boggling that this got turned into the mess that it did. Like looking at it. You know, hindsight is 20 20, but it's very sad what it has done to our health as women because we really have deteriorated. You have seen the incidence of diabetes and obesity and insulin resistance just shoot through the roof. And the cardiovascular disease and the heart disease. Heart disease is the number one killer of women after menopause. Not breast cancer. Breast cancer.

It's actually true before, in every decade of a woman's life after she's 30, women die exponentially more of cardiac disease than they do of breast cancer. So you know the 30 year old has a significant fear of breast cancer, right? They all do. And yet their real threat to their life is their heart health.

Right. And it's all because of the emotions that we put around it, right? We, we, when we think of breast cancer, like it eats at our femininity at who we are as a woman and it's going to destroy us if we possibly have breast cancer. Because we're going to be deformed, we're going to be seen differently, our husbands aren't going to want us. All of that emotional baggage is wrapped up in that kind of diagnoses. And it's very sad because conventional medicine capitalizes on that. And so as soon as you get that diagnosis, you're like shot off to the surgeon and all these decisions happen before you even have time to process it emotionally or mentally and think, what is the best thing for me? Because they put the fear in you. You're going to die, you're going to be deformed. You better remove that cancer and get your new breasts asap. Like, let's not even think about anything. Let's just fix you and make you look like nothing ever happened and then you can go about your business and your life. And so women are like shot. I just think of it like it's going 100 miles an hour and you just like have all this done before you can even breathe. And you turn around and you go, what the hell just happened? Like, I just had five surgeries, chemotherapy, lost my hair, got a wig and now I'm back onto my life and I'm cancer free. Amen. And like, that's not how we should be handling it. It's so sad.

It Is so sad that they do get put right on that conveyor belt. Right, Exactly. I mean, listen, the bottom line is that cancer is big business. It's big business. And one of the first things that I tell people when they get a breast cancer diagnosis is you have time.

Amen.

Right. And you have time to think, you've time to decide, you have time to feel. You have time to do everything that you need to do to make this the right way for you. I fully believe that disease is reversible with very rare exception or sometimes it has gone so far that you can't come back. There's so much end organ damage. But for the most part, diseases are reversible. Have to change.

You just have to remove what's angering your system. What are you doing to your body, what is triggering this response and remove those triggers. And your body will able to go back and do what it needs to do. Like I explained to women, as a surgeon, I'm going to go in and deliver this baby by C section. I cut through your skin, I cut through your fascia, I cut through the muscle of the uterus, I cut through all of these things. I suture you all back up together. But I don't actually heal you. As soon as you take those sutures out, you'd be wide open, your guts would be hanging out on the floor. Your body does the healing. Your body puts those tissues back together. Surgeons are not the miracle workers. Your body is the miracle worker. It's incredible that we have just lost sight of that ability of our body to do that.

Yeah. It's so true. It's so true. And we don't give ourselves enough credit.

No, Right.

Because our bodies are capable of so much. God created us as perfect beings. We know how to heal. We just need to get out of our own way a lot of times.

Right? Exactly.

Yeah, exactly. Exactly. So let's talk a little more. Let's dive deeper into the hormone story Because I think you and I absolutely agree that hormones do not cause breast cancer. What do they do? What do they do for people?

I truly believe hormones make you who you are. They make your personality, they give you your health and your vitality. I went through a transition where my estrogen dropped down to nothing. And I didn't want to get off the couch for three days. I was so depressed. Like, I didn't love my husband. I didn't want him to talk to me. I wanted to give up my business. It took me three days to figure out that I needed estrogen and that was an eye opening experience. Like, wow, that really changes who I am. It gives me drive and motivation, it makes me happy, it makes me loving toward people. And without that, I was a crotchety, miserable, you know, shell of myself. And so it really does make you who you are. And there was an incredible study done about women on birth control pills. And they found that women on birth control pills were attracted to different men than they were off the pill. They were attracted to a less masculine men, a more feminine face. And I just think about like, huh, I wonder if I would have had different life partners had I not been on these birth control pills. Because it changes the way your brain chemistry works and what you desire and what you think. And so those synthetic hormones can really mess with women. And I've heard it for, you know, 20 plus years. Like, it makes me crazy, it makes me anxious, it makes me sad, it makes me snappy. I don't feel like myself. I don't know who I am anymore. I. And you know, different pills have different variations of these responses. So it really is changing the brain chemistry and who we are. And people think that's like just in our head, but we have estrogen and progesterone receptors throughout our entire body. That is why the majority of Alzheimer's happens in women, because estrogen is protective to our brains. And after menopause, we no longer have that protection. So we, we just think of estrogen as the uterus and the ovaries and that's it. And then maybe the breasts, but it's everywhere through our body. That's what makes our skin tight and beautiful. That's what helps our bones stay strong. That's what keeps the arteries in our blood vessels, like elastic and mobile to pump our blood pressure. So as soon as you lose that estrogen after menopause, your arteries get stiff and they harden and they have to, you have to increase your blood pressure to push that.

Yeah, I was going to say blood pressure goes up exponentially.

No squeezing of the artery, it's like a hard tube now. So you, your heart has to work harder so your blood pressure goes up, your cholesterol numbers go up. This is shocking to women because cholesterol, you know, this is actually the main ingredient for estrogen, testosterone, progesterone production. So if we're no longer making all those hormones, all of a sudden we got all this cholesterol sitting there in our liver and it takes our body a while to go, wow, we don't need to make all of this anymore. And everybody panics and says, oh my gosh, your cholesterol levels are up, your blood pressure's up, here's your five drugs that you need. And you're just making the problem worse because what's happening is your body's just transitioning to a body without the amount of estrogen. And it takes a minute for all those changes, you know, to balance out. But by and large, aging starts to set in as soon as those hormones go bye bye. Like the aging process does happen. Women are like, wow, all of a sudden I have wrinkles. All of a sudden I've lost the collagen in my face and my skin.

And it happens pretty rapidly. It happens pretty rapidly because unlike men, where male menopause is a long, drawn out affair where they just gradually lose testosterone over time, women go from having enough hormone to ovulate to not having enough hormone to ovulate in a matter of months.

Right? And here's the kicker that a lot of women are missing and definitely conventional medicine is missing. When your ovaries are done, they've had their life expectancy, they're no longer going to produce that level of hormone. Your adrenals are your backup ovaries. Your adrenals are going to provide you with the hormones you need into the menopausal transition. So if you go into menopause with tanked adrenals, you don't have a backup plan. You got nothing. And so that is what we're seeing more and more of because we are living in the most stressed, best out time in history with the thousands of chemicals that we've produced in the labs that our bodies have never seen before, all the plastics, all the pesticides, all these toxins working like 10, 12, 14 hour days, trying to do all the things right. We go into menopause with adrenal fatigue, tanked adrenals, and then we expect them to give us the sex hormones that we now need from them. So that's why your great grandma had such an easier transition than you did going into menopause, because you don't have any backup ovaries.

Yeah, it's so true. So, you know, I think for the woman that is having hot flashes and mood disturbance and sleep disturbance and vaginal symptoms and no libido, like I think that, that, that woman, it's very obvious that they need hormone replacement. But what about the woman who is asymptomatic, who is, you know, going through menopause in, God rest her soul, the way that Susan Love described it, which I think that she was actually a huge detriment to the woman's movement in saying that, you know, menopause isn't a thing and we should all celebrate it because most of us do not celebrate it. But for the woman that's asymptomatic through men, menopause. What are you saying to her?

So I always like to remind women that just back in the 9th, like 1900, so 123 years ago, women died at menopause. The average life expectancy was 49. It is now 83, 100 years later. So we did not live in a menopausal state the way we do now. We live almost half our life. If you're blessed like my family, they're living into their 90s. I have half life of menopause, right? I'm not going down like that. That's an individual decision. I got my estrogen patch on, I promise you. Because I say to women, be excited that you actually have a choice at this point in your life, because we didn't always have a choice. And you can just transition into menopause gracefully and do what you want to do. Feel like that's what your body naturally wants to do. Understanding modern medicine has helped us live so much longer that you're going to have to possibly suffer all these lifestyle conditions and diseases that your great grandmother never had to. The obesity and the diabetes and the heart disease and all of the things and the cancers.

I think it's more than that, though. I mean, I worry about the stuff that they are not. They're not picking up on. Like obesity is obvious, you know, you know, that you have a weight problem, diabetes, maybe not so obvious. But, you know, if you're checking your labs every year, you know, but you don't know that you're developing Alzheimer's. You don't know that you're developing osteopenia. You don't know that you're developing heart disease, right?

And so I get women who are 65 or 70 coming to me going, why didn't anyone tell me? This isn't fair. Because now my brain doesn't work. Now I have, you know, fractures in my hips and I'm having all these surgeries. Like, why didn't anybody give me this option to take hormone replacement therapy for all of this silent killing that's happening. So you're absolutely right. That is so important. That's what I say is it's not about symptom relief. It's not the band aid medicine. Again, it's about, I think of it as suspending yourself in your 48 year old healthy self and holding onto that vitality as long as you possibly can so that all these disease processes don't set in. And I don't see anything wrong with that. You know, like that is my plan. I need my brain to function. I need my body to move and function and do all the things. My mom wishes. She would have been on hormone replacement therapy, but that conversation never happened because she went through it during the WHI fiasco.

Yeah. Yeah. So what are you saying to your 40 something who is perimenopausal and how are you preparing her for this? And what is, what is her plan? What is her lifetime plan?

I like to explain that perimenopause can be a little bit of a roller coaster. And if your adrenals are a mess and your diet is a mess, you're not managing your stress and, and sleeping, that roller coaster ride is going to be horrific. And so you want to dial in all your foundational stuff to really minimize the effects of what's happening to your hormones. You have to be getting good sleep. Like that's absolute must to keeping your weight in check and keeping your energy levels up. You have to eat clean. You cannot eat like you did when you were 20. You have to keep moving your body because especially our lymphatic system, you know this, it tracks along with our cardiovascular system. All our blood vessels have little lymph vessels running alongside it, and that is taking out the trash. But they don't have little pumps like our blood vessels do. So if you don't pump the lymphatics, you don't take out the trash. And so you have to keep moving your body. And I see so many women get sedentary, in their 40s and then they're like straight up done. Because once you start having hormone imbalances and your estrogen starts to drop, you're in pain, your joints hurt, your muscles ache, you get muscle cramps, you have all these problems and so then you're really not exercising and moving your body. That lymph never gets squeezed and pumped out, the trash never goes out and you grow cancer cells. That is what's happening is you're not doing what your body do. So you have to be moving, you have to be eating clean, you have to decrease the alcohol, all of the things, and that transition will be smoother. And I say pay attention to your mood and your personality. If you start to become angry, snappy, short tempered, if you're crying for no reason, if you're pulling away from your friends and your family and you just want to be alone. You probably need estrogen. Estrogen is our body's natural antidepressant hormone. It makes us feel good. Progesterone is our anti anxiety hormone. If you're so anxious that you can't even handle things you used to handle before, you can't turn your brain off and go to sleep. You're just wired. It's because you need progesterone. So like, I look for these cues in women's personality to help me figure out. And then we do testing, because test, don't guess right. Let's just know for sure. And by and large, I get it right most of the time. Like, yup, are you ready for some progesterone? And that is probably the game changer for most women. Oh my gosh, I just had the most amazing night of sleep. I can handle my job again. My kids aren't driving me crazy. Like, this is a game changer. And that's one of the saddest things about conventional medicine is we are not taught the difference between progesterone and all those synthetic progestins.

Well, so let's talk about that. Let's talk about that because I think that that is a topic of a lot of debate and I have been accused of just being a marketing person or because I talk about bioidentical and there are a lot of people out there who think that I'm just trying to sell something. Let's talk about what the difference is and what your feeling is about the synthetics.

The difference is night and day. When I was in conventional medicine for all those years giving depo shots and IUDs with, with synthetic progestin hormone in it or the mini pill. After a woman had a baby and we didn't want to give her estrogen because she was breastfeeding, and it can affect your milk supply. So I'm giving all of this progestin in one form or another. There's like a zillion different types. By and large, women do not feel good emotionally on progestins. They feel depressed or anxious. They. They always gain weight and they just don't feel good. That is the complete opposite. When you take progesterone, the chemical that our body makes. So what it means is that at the chemical structure, the little carbons and the hydrogens, all those molecules are in the same exact place as the hormone that we made. We use the word synthetic to refer to a chemical that has a Different structure. It's a bad terminology. I wish we didn't use it, but that's what we mean when we refer to synthetics. So progestins are synthetic because it's not the same chemical as our body makes. So it kind of does the same job on the uterus. It says, stop growing too much. Don't overgrow. But it doesn't do that in the rest of the cells of our body. It doesn't have that same appropriate response as progesterone. And so you get all these side effects and you don't feel good. And so we didn't understand that in conventional medicine. We just figured they're close enough. They get grouped together as this one big family. I saw it over and over. You know, we would read studies, and we'd have to study the studies and try to pull apart the holes and figure it out, because that's what you do as a scientist. You try to. To really understand things. In huge, big, important studies, they would use the word progestin and progesterone interchangeably as if it was one thing and they were using the wrong word to describe the chemical. So it's like even in our studies, even in our history books, everything, it's all misnomenclature, all a big fat mess. And so gynecologists don't understand the difference. And there is a. A huge difference. So when we say bioidentical, what we mean is it's chemically what your body makes and what it wants. It's not a little bit altered like a progestin. And that can be enough to increase your risk of cancers and diseases and side effects and things that you don't want.

Yeah. And let's go to the cancer story a little bit, because what you're describing right now, that's the tamoxifen story. People think that. They think that estrogen causes breast cancer, and then they take tamoxifen. Tamoxifen is nothing more than a synthetic estrogen. And in the breast, it acts protectively. But what did it do in the uterus.

Of uterine cancer? Yeah.

And it's so amazing to me that people are so bought into the estrogen causes breast cancer story. And then they're taking a synthetic estrogen to prevent breast cancer, and it's acting like estrogen, which is protective. It's acting like estrogen in the breast, and they're willing to accept getting a uterine cancer.

Right.

And so we have so bought into this narrative. I have a. A Facebook group called keeping abreast. And I spend half the time in that group explaining and re explaining how estrogen doesn't cause breast cancer because people get estrogen positive breast cancer, progesterone positive breast cancer. And what people don't understand is that normal cells, normal breast cells, have estrogen and progesterone receptors on them, just like brain cells, just like heart cells, just like the cells that are. Just like the cells that are part of our blood vessels, just like our bones, just like our skin.

You want them to have those on there?

Yes, yes. That's the normal part of your breast cancer is the fact that it has estrogen and progesterone receptors on it, because that's the part of the normal breast cell that it's retained.

Yes.

It might have an upregulation because that cell wants to live. And so it's desperately looking for its source of life, which is estrogen and progesterone. And what do we do to these women? We take away their estrogen, we shut down aromatase and we prevent these women from having estrogen. And we have condemned them to a life of depression, anxiety, heart disease, osteoporosis, Alzheimer's. Like we are allegedly saving their life from breast cancer and condemning them to something that is far worse.

Right. When they were never going to die in the first place. That's the saddest part of all of it.

I know, I know. It really is sad. So I know the conversation you're having with the 40 some year olds, what does that conversation look like when people are 50, when people are 60? Now, I know you're still talking to them about diet. I know you're still talking to them about prioritizing sleep, about avoiding toxins, about moving their body. Right. But when do you stop recommending hormone support?

I still have the conversation with every woman. You know, more and more I'm getting women over 65 wanting to have a hormone conversation with me. They've heard that it's protective and beneficial and they want to get on them ASAP because they already have osteoporosis and brain fog and brain memory issues and all the clear signs that they've been depleted for so long or they had the breast cancer, they've done all the treatment and now they're miserable. Miserable. And they're coming to me. And I have to be honest, like you mentioned, once those disease processes have started, you can't necessarily just give the hormones and have it completely reversed. You're not going to see that happen. And so the question is let's have a discussion on risks and benefits. And my, My concern is going to be blood clot and stroke from adding estrogen back in after more than a decade of not having it. It. I'm not worried about causing them cancer. That's not gonna. That's not what causes cancer.

Right, Right. And I will say that people on hormone replacement can get breast cancer just like people not on hormone replacement get breast cancer. Right. Because breast cancer is an environmental disease. And if you are, you know, if you over your lifetime have been exposed to things that are chronically inflaming you, being on hormone replacement is not going to take that away. It's also not causing your breast cancer.

Right. And breast cancer, your risk increases with every decade that you live because you're exposed to these environmental toxins longer and longer. So if you're on hormones at 50, 60, 70 years old, you're going to have that risk of breast cancer when you're 50, increase when you're 60, increase when you're 70. So it's not because you're on the hormones. It's because. Because you're living this toxic life that we're all living. And you're not necessarily figuring out how to mitigate and stop all of that from coming into your body and attacking your body.

And what's interesting is that when we see the women on hormone replacement develop breast cancer, they actually have a better prognosis than the women who are not on hormones. Now, I don't know if that's a generalized state that women on hormone replacement may be taking better care of themselves or they just are physiologically younger because they're on hormone replacement. I don't know which one it is, but I do know that they do better. Yeah.

And now that the pendulum has swung the other way from the crazy WHI study 20 years ago, so we're going to start to see studies and results from that, because women are back on hormones. We're no longer fearing it. We've wised up to the fact that God did create our body to thrive with hormones. And so we're going to see these benefits. We're going to see that shift and that transition. But women just need to have that discussion. I believe you deserve those opportunities to make those decisions, and you shouldn't be just thrown on the conveyor belt with no discussion. I have so many patients who come to me and they're like, I regret having the reconstruction. I regret the chemotherapy. I regret all the things. Like, I have someone near and dear to me who Just finished chemo and they made her go off all of her vitamins and supplements for it and she could barely function. She's like, when can I go back on my energy lift? I said, get your butt back on that. You need those B vitamins. And she was back.

You know, it's just so sad because they don't know what any of these are and what any of them do. I remember having a discussion with one of my patients that the medical oncologist insisted that they go off medicinal mushrooms for chemotherapy. And I said, you know why? It's part of chemotherapeutic regimens all over the world. Why? And they just don't know. And so when they don't know, they just say no, right? Yes. And so I said, go back and ask them if you can eat mushrooms. And if they say you can eat mushrooms, then you can take mushrooms. Right? Just powdered broth.

Yes.

But I think that people encounter that all the time. And they encounter. First of all, they have a tremendous amount of personal fear. They're afraid they're going to die. There is no worse diagnosis for a woman than a breast cancer diagnosis. They're afraid of their life. But it's also such a public disease. Disease. Right. It's everywhere in the media. But it's also. It's an external organ. So it's like you can't even really go through it privately. It's an external organ. And so there's that. There is a tremendous amount of pressure from the conventional medical system to do exactly what you said. Get on that conveyor belt and get it fast. Right. We want you scheduled for surgery. We want you schedule going to put your port in. We're going to get you chemotherapy. And I actually have a patient right now that is in between treatments and the radiation oncologist is pressuring her because you only have seven weeks to get radiation.

Really? Why?

Why? What's going to happen at the 50th death? Is she going to magically recur on the 50th day? Because she didn't get radiation within seven weeks. And it's just. I understand why they practice the way they practice because this is how they were trained. And once you're trained, unless you have you had a pain to purpose experience. I had a pain to purpose experience, but otherwise you probably would have kept your blinders on and gone full steam ahead like you were going. And that's what they're doing. I mean, they're doing what they believe in and what they've been trained to do. And so patients are under a lot of pressure to make these decisions, to get on that conveyor belt, to get that treatment. And their families are pressuring them too.

Oh, yeah, for sure. Yeah.

And so. So it's a really hard spot to be in. But for the women that didn't have the chance to think, didn't have the chance to investigate, they weren't really participating in their decision. And they had the surgery that they regret and they had the chemotherapy that they regret and they had the radiation that they regret. And they are now a shell of themselves. Their relationship is awful because they are so depleted. They're not interested in sex, they're not interested in intimacy. They're grouchy, they're snappy, they're not sleeping. How do you approach that woman that had a hormone positive tumor and now has a life that is barely worth living?

I have a lot of those patients and they almost always are opt to do hormones. They opt to have their life back, Especially if they had a complete mastectomy, you know, then they really aren't worried about it. But I would say even if you haven't, if you've had a lumpectomy, the benefits far outweigh these supposed risks that are out there. I think the biggest hurdle for women is finding doctors who are on board and understand this because they get so much pushback and they get treated poorly. They get threatened to be dropped as patients if they're on hormones. I hear all kinds of crazy stuff and I'm just like, how can you practice like that as a physician? My goodness, like, where is the dialogue? It's so paternalistic. It is so old school, straight out of the 1930s. Like, I'm the doctor. What I say goes. You don't have any say in your own body. Like that. That blows my mind. But that is still how many, many doctors practice and well, and we've had three years of.

That is the way to practice, right?

Oh, yes. You are better than everyone. The, the coat tells where you are in the hierarchy, you know, And God forbid a nurse wear the same kind of coat that you wear because they are below you. Like this is the mentality in the medical system. And that's what you are trained. You said is so right on how you are trained is how you're going to practice until you retire unless you have some come to Jesus moment. Because we're all just in survival mode as doctors. We're working our butts off. And it's not that we don't care, but there's no time to, like, be a lifelong learner and go learn new things and try new stuff unless it's driven and required by your hospital system. You know, like, when I learned the robot that was all financially driven by my hospital system, I ended up loving it. But that's not something I'm just going to go off and do. I don't have time for that when I'm seeing 40 patients and doing deliveries. I'm exhausted.

Yeah. Yeah. Well, I know you have other things to do today, and I've kept you quite some time. So what is it that you really want people to hear? What is the message that you really want people to know now?

Well, we've kind of been sprinkling it in this whole time, but it really is that you are in control of your health. You have way more say in what's happening with your body than you may realize. And so I invite women to just keep listening to podcasts and reading and sharing their stories and listening to other women's stories, and you'll realize, like, oh, my God, I can be empowered because I can actually change my daily choices, and that can change my health and my outcome with my life. I just need to find the right resources, the right people. So if your doctor is not equipped to have these conversations about hormones or flat out refuses, you just keep looking. You find a new doctor because you are the CEO of your health and your body, and you have way more rights than you realize.

Yeah, I love that you're the CEO of your health, Dr. Tabitha. Where can people find you?

You can find me@drtabitha.com I'm on Instagram at the Gutsy Gynecologist on TikTok, Facebook on Dr. Tabitha kind of all over the place. And the gutsy Gynecologist show my podcast. Yeah.

Oh, great. So we'll make sure we put that all in the notes. Thank you so much for being here today, for sharing your wisdom, your brilliance. I love how relatable you are. You're very real, and you've. You've lived it, you've seen it, and you walk your talk, and you're. You're. You're definitely someone that I admire greatly.

Oh, my gosh. Right back at you. I feel like we're both kind of on this similar journey, kind of parallel lives, you know, and. And we just need to keep reaching the women and helping as many women as we can. So thank you for all that you're.

Doing, and I hope we reach some practitioners, too, right?

Yes.

Yeah, thanks. It's Dr. Jen Bye for now. Thank you for joining me on this episode of the Keeping abreast podcast with Dr. Chen. I hope you found the disc discussion informative and empowering. Remember rest, health is health, so by staying informed and taking proactive steps you have the power to optimize your well being. My team and I encourage you to apply the knowledge gained from today's episode to make positive changes in your life and share what you've learned with others. If you enjoyed this episode, please subscribe to our podcast and leave us a review. Your feedback and support mean the world to us and help us to reach more people who can benefit from these conversations. Stay connected with me on social media where I share additional resources, advice, updates and announcements related to breast health. You can find me on Facebook, Instagram and YouTube. Dr. Jennsimmons and remember, my Jen has two N's, so until next time, remember to stay proactive, informed and confident in your breast health journey. The key to your health is you.