The Truth About Estrogen, Breast Cancer and Hormones with Dr Deb Matthew

Hi there, it's Dr. Jen. Welcome to my YouTube channel. Last year I recorded the beyond the Cancer Summit and I had so many great speakers and I know it's so hard for people to attend a whole summit. So it's, you know, it's a five day commitment and even the people that purchase the summit and are able to go back later and listen, it's still a huge commitment and we know that we over commit, all of us over commit. And so I wanted to make sure that people had access to this information easily. You know, half of the time I buy summits and then I forget my username, I forget my passcode, I send an email and by the time the email comes back, I don't even have time to watch it. So. So I wanted to make sure that many of these talks you were able to easily get access to. So one by one I am uploading them to my YouTube channel. So today's talk is with Deb Mathew. Deb is an ob GYN and she is, I believe, either the president or the past president of the North Carolina Integrative Medicine Society. And she is a brilliant woman who does the research and really has committed her life to making women's health better. And she is doing it. She is doing it every day. And last year we were at a conference together and we had this conversation. She was like all up in a rage and she said, you know, I just reviewed all the data on hormone replacement and I don't understand why people still think that hormone replacement causes breast cancer. And I said, you know what? I have the perfect place to plead your case. So I have my right hand person with me today. Stephanie. Stephanie, why don't you go ahead and cue the video and I may talk a little bit over it. Oh dear. I can't hear it.

Can you?

Nope, I don't hear anything beyond the cancer summit. I'm your host, Dr. Jen Simmons, and I am excited for all of you to hear from our next guest. This is a lady that is going to help you immensely because she is busting hormone replacement myths. The real truth about estrogen. And I know that this is a very controversial topic. It's a hot button for everyone, but really everyone wants to know what the deal is with estrogen. Dr. Deb Matthews is the happy hormones doctor. She's a best selling author and international speaker, educator, wife, mom of four boys. God bless you. I have two and I didn't have a third because I was afraid I would get a third boy. After suffering for years with fatigue and Irritability, which led her to change everything about her practice of medicine. I can't wait to hear your story because I think we have a lot in common. She's been featured on national podcast radio broadcast shows including NBC, abc, CBS, and Fox. And she is here today for the beyond the Cancer Summit. Dr. Matthew, welcome.

Thank you so much for having me.

Can you first share a little bit of your story and how you got to be the happy hormone doctor?

Yes. Well, back in the day, I was a regular doctor like all the other doctors, and I was exhausted all the time. Napping was my favorite hobby, and I was freezing cold all the time. I took sweaters with me everywhere. I live in North Carolina, which is really hot in the summer, but I take a sweater because when I went in the air conditioned restaurants and movie theaters, I would just shiver. And it got to the point where I was shrieking at my kids over every little thing. My poor husband was afraid to come home at the end of the day because he wasn't sure if he was going to find the Wicked Witch of the West. And I didn't understand what was happening to me. There was really nothing in my medical trip training that explained what was going on. I knew that I was hypothyroid and I was on a pill and my thyroid labs were normal. So it, it I was taking Synthroid. Exactly.

And Synthroid. And all your labs are normal.

All my labs were normal.

And so all the ones that they measure. Right.

Well, very true. And so.

Right.

So when that's the case, either you need to get up off your lazy butt and go exercise or maybe you need an antidepressant. But what changed everything for me is that I found a book that was written by Suzanne Somers about women's hormones. And that book blew my mind because in medical school, they didn't explain what all these different hormones did and how they made you feel. They just talked about fertility and menstrual cycles. And once I understood what was really wrong with me, why I was so cold all the time, why I was so tired, why I was irritable and negative and critical, it allowed me to get my hormones back in balance. I was able to get my energy back. My kids got their mom back, my husband got his wife back, and I got my life back. But then I couldn't just go back to writing prescriptions all day long because it just didn't make any sense anymore. And so I completely retired and I retrained. And now for the last 15 years, I've been Working with men and women to help them get their hormones back in balance so they can live their life to the fullest and. And love the way they feel.

So just to share with people, what was the imbalance that you found?

I had a bunch of them. So that Synthroid that I was being given was making my lab tests look normal, but it wasn't making me feel normal because I wasn't able to properly use the kind of thyroid in the pill.

So just to review for people, Synthroid is synthetic T4. T4 is our inactive thyroid hormone. So despite the levels of T4 being normal, if you can't convert T4 to T3, which is the active form, you feel pretty lousy. And there are lots of things that interfere with that conversion of T4 to T3. But you can measure the labs and they can look perfectly normal, and yet you feel the way that you feel.

And so when I switched over to a natural form of thyroid that had some T3 in it, my entire life changed. But there was more. I was stressed and my cortisol levels were out of whack. And that was part of why I couldn't properly convert the T4 to the T3. And I was on birth control pills which were shutting down my testosterone. I mean, I just had layer upon layer. But once we just unwound those layers and I got my hormones back in balance, everything about my life is different. And I would never go back.

Awesome. So now you help people who were. Who are suffering in that same kind of way where all your labs are normal, but you feel awful. Yes. So what is your approach? Where do you start with people who have the. I just know something's not right.

Yeah. That is the number one thing that I hear when women come to see me is, this is not me. I just want to feel like myself again. And so we start off by taking a full history because there are certain symptoms that go along with different hormone imbalances. And so when we get a really good, comprehensive history, we get so many clues about what's going on. And, you know, so often in doctors offices now, they don't want to hear your whole story. If you're here to talk about your headaches, then you're limited. Today you can only talk about your headaches. If you've got a problem with constipation, that has to be another appointment.

They don't want to hear about that.

Crazy. So.

But.

But we want a whole history, and then we want to measure hormone levels because we can't, you know, we Want to know your unique pattern? We're all very unique. We all have different hormone levels. Even if you're going through menopause, sometimes estrogen levels go up before they go down. And not everybody who goes through menopause is deficient in every hormone. So we really want to understand, and it's not enough only to know the hormone levels, because we also want to know about many of the different factors that impact our hormones. And some of those are things that we're going to talk about today, but how your body is able to process the hormones, the different cofactor nutrients that are needed. There are many things that go into what our hormone patterns look like. And so there are things that we can do to help restore balance, because this is all about balance. That's the important thing, including lifestyle changes, nutritional supplements, and then sometimes the bioidentical hormones.

And as you were saying, our hormones are a symphony, right? It's not just estrogen and it's not just progesterone and it's not just cortisol and it's not just dhea and it's not just testosterone because they are all interacting with each other and their levels are dependent on one another. And I'm going to throw melatonin in there, too. That people who are looking at things in isolation, you cannot help the person if you're looking at things in isolation because they're not working in isolation.

And you've probably already talked a lot about melatonin, but people always think about it for sleep. But even if you're sleeping soundly, sometimes we find your melatonin level is low. And it's such a powerful anti cancer hormone that we would want to know that, right?

So melatonin is our healing hormone. So if, if cortisol is our flight and, and fight hormone, melatonin is the other side of that. That's our rest repair, regenerate. And if you're not sleeping, sleep is when we make our melatonin. So if you're not sleeping because the rest of your hormones are out of balance and you're not making melatonin, this is the recipe for developing breast cancer. And so many people who come to me say, yeah, I just don't sleep. And that's actually their why. We try to figure out with people why they got breast cancer. Not for blame or shame, but in order to restore your health and have a healthier you on the other side, which I always say for my patients, they are healthier after their diagnosis than.

They ever were before.

It is A complete shift for them. And if you're not making melatonin, if you're not sleeping, this is a recipe for cancer. So estrogen has a really bad rap. Right? So can you talk a little bit about where this. Where this bad rap came from?

Yeah, this is something that I talk about all the time, and it makes me so angry because there are so many women who are suffering with all kinds of symptoms that are very preventable, but they're suffering because they're terrified of estrogen, because everybody knows that estrogen causes breast cancer. Or they went on hormone replacement therapy, and subsequently they ended up with a breast cancer diagnosis, and they were told that estrogen caused their breast cancer. And so now they have this guilt or, you know, that they. They did something to themselves that caused them to have breast cancer. So back in. Back in the day, when I was in medical school in the early 90s, we were all taught that all menopausal women should go on hormone replacement therapy because it was going to protect their heart and their brain and their bones. And we were very paternalist. Like, we gave everybody the same pill, and if you didn't take it the way we told you, then we shook our finger at you, you weren't a good patient. But because it was the same dose for everybody, it wasn't the right dose for everybody. And lots of women had side effects and they didn't feel good and they didn't want to take it. So there was this giant study that was done that was going to prove once and for all just that hormone replacement therapy was the greatest thing since sliced bread, and all women needed to be on it. And unfortunately, what happened instead is that there was a finding that there was an increase in the risk for breast cancer. And that hit the media, and overnight hormones went from the greatest thing to slice since sliced bread to scary, bad, dangerous. You're going to die. It's going to kill you.

What hormone were they using?

Well, so they were using Premarin, which is conjugated equine estrogen. So it was a kind of estrogen from horse urine, which isn't bioidentical, meaning it's not the exact match for hormone that women's ovaries used to make. And they were pairing that with a synthetic kind of progesterone. So it wasn't actually even progesterone. It was a synthetic chemical. It was man made, never before found in human bodies, but it was readily available. It was kind of like the standard thing that we were using. And so this combo Pill of estrogen with this synthetic drug of progestin was increasing the risk of breast cancer by a little bit. There were about seven extra breast cancers per 10,000 per thousand women, which isn't a lot. I mean, you were still 99% chance you weren't going to get breast cancer. But nonetheless, we were telling everybody that they should be on these pills and.

But they did stop the. Let's just pause here for one minute. I actually don't remember. Oh, what a bad pause point. I actually. It's fine. I actually don't remember if we end up talking about this. But I want to make sure that I get this in here at this time because there were so many problems with that study. But I do want to point out that this study was powered to determine whether or not hormone replacement is protective against cardiovascular disease. Now, the vast majority of the deterioration in the tissues, the deterioration in the vessels in the heart, the deterioration in the brain, the deterioration in the bones, that happens within the first 10 years. It's really accelerated in that first 10 years. And then after that, it kind of stabilizes out. When they enrolled for the Women's Health Initiative, the average age of enrollment was 63. The average age of menopause in our country is 52 already. The average age of women is 10 years past when their menopause statistically happened. We've already passed the window of benefit for these people. The other thing that I want to mention is that there were people enrolled in this study who had previously been on hormone replacement, and then we're randomized to not getting it. So if you're 63 and you've already been on hormone replacement and now you're going off and going into this not hormone replacement group, the numbers are going to be skewed because in truth, the estrogen is protective. And so there was a lower than acceptance expected rate of breast cancer in the control group. So it wasn't that the group that got hormone replacement really got more cancers. It was that the group that was being compared to had a lower than expected rate of breast cancer because they had already been on hormone replacement. And we really don't talk about that detail. So I wanted to make sure that I mentioned it here. There are so many flaws with the study. Dr. Matthew is going to talk about more of the flaws with the study. But the study was not powered to determine if hormone replacement causes breast cancer. So we highly, highly, highly extrapolated that fact. There was a lower than expected number of breast cancers in the control group because they had already been on hormone replacement and the average age of the study was too old. We were starting people on hormone replacement beyond 10 years beyond when they went through menopause. And this synthetic estrogens and progesterones may have played into it. But I think the other things that I spoke about play more of a role in what was wrong with that study and why we can't trust the results. So let's get back to Dr. Matthew.

Study early. And doctors got totally freaked out because we don't want to do anything that's going to increase the risk for breast cancer. But we've had 20 years to go back and understand, and we understand so much more. And what we understand now is that there were two groups of women in the study. There was the group of women that got the combo pill, the horse estrogens, with the synthetic progestin, and they had a very small increase in the risk for breast cancer. But there was another arm in the study were women who had had a hysterectomy and they were given just estrogen all by itself. It was the horse estrogen, but it was conjugated equine estrogen.

And let's just clarify. The reason that they could do that is because you can't give estrogen alone to someone who still has their uterus intact because it is stimulating and can increase the risk of uterine cancer. So you need the progesterone to balance that. And that's why the estrogen alone was only given to women who had their uterus removed. Right.

So if we talk about that group of women, because estrogen is the hormone that got the bad rep. And so, and when we talk about hormones or hormone replacement therapy, we just lump it all into the same basket as though it's all the same.

And we call it all estrogen and we call it all estrogen to me. But guys, let's keep going.

Let me just share my screen, if it's okay with you. I would love. And I want to just quickly run through some of the data. So in the women that got the estrogen only pill, if they happened to be in the fifth, in their 50s when they started on hormone replacement, because in this big study, the average age of women was 70, so they were far past menopause. But if we look at the younger women, they had less heart disease, less strokes, less breast cancer, not more breast cancer, less breast cancer and less risk of dying from any cause if they were on the estrogen pill than if they didn't have any hormone replacement therapy. So These are the younger women. So even today, the powers that be, the official recommendations is that for women in their 50s who don't have other extraneous risk factors, the benefits of hormone replacement therapy far outweigh the risks. But let's look at women who were in their 60s. They still had less heart disease, they still had less breast cancer, but now we were starting to see a little bit more blood clots. And of course, a blood clot in your brain would be a stroke. And remember, they were getting oral estrogen. And we know that if you give oral Premarin, there is an increase in the risk for blood clots, oral estrogens of any kind, whether it's birth control pills or hormone replacement therapy. So we know that.

Yeah.

And whereas if we do it topically, we don't see the same risk for blood clots. So for women in their 70s, there was the increase in the risk for blood clots, which can cause the strokes. And also, blood clot in your heart would be a heart attack. And so we saw some increase in the risk because we were giving them oral estrogen, but there was still no increase in the risk for breast cancer. So in none of these women at any age was estrogen increasing the risk for breast cancer. So we also. I just want to run through some studies because I feel like if some doctor on some summit says something that is different than what your own doctor is telling you, you shouldn't just listen to random people. So I want to back this up by some studies that were done long after this Women's Health Initiative study that we're talking about that blew the lid off the water was 2002, so 20 years ago. So here's a study from 2010 that showed heart attacks, heart failure, and death are reduced by 40%, which is a lot when we start HRT in women who were in their 50s. But another thing that we should talk about here is what form of hormone replacement therapy we use for women really matter. So we can use the pills, but that increases the risk for blood clots, and then, you know, heart attacks and strokes that are caused by the blood clot. But if we use bioidentical hormones, so we can use estrogen, that's bioidentical, meaning it's an exact match. So at least in theory, your body can't tell whether it came from the pharmacy or whether it came from your ovaries. Even more important, though, than the estrogen is the progesterone. Because what we know is if we give you bioidentical progesterone. Now, the progesterone is the exact same match from your ovaries, not the synthetic man made chemicals that we used in the study. When we use those bioidentical progesterone, the studies do not show an increase in the risk for breast cancer. Because if you're a woman who has your uterus, you need some kind of progesterone to protect your uterus. So Here's a study 2012, 10 years ago that showed that if we give you transdermal estrogen, estradiol is the bioidentical form of estrogen, then we do.

It's coming through the skin, so coming through the skin.

So a patch, something like that. Then we don't see the risk of blood clots and strokes. And I added the word bioidentical. They just called it progesterone. But the synthetic ones are called progestins and there's all different ones. But if you use actual bioidentical progesterone didn't increase the risk for blood clots and it did not increase the risk for breast cancer, which is really, really important. So here's just a few more studies. This is1 Again, 2012, 42% reduction in death from any cause in women on hormone replacement therapy. And even if you'd stopped the hormones, you still had a 33 reduction in risk of death six years later. Here's a study that showed that if you took the estrogen with the synthetic progestin, there was a marginal increase in the risk for breast cancer. But with estrogen alone, breast cancer decreased significantly, as did mortality. The estrogen didn't increase their risk for breast cancer, it decreased significantly according to this study, as well as decreased death from any cause. They even go on to say there is great consistency between all randomized trials, including that one that told us that everybody was going to get breast cancer, showing that there's a heart benefit and a decrease in all cause mortality, meaning death from any cause. This is 2014. Here's another one. For women on estrogen therapy, there is more benefit than risk for symptom control, preventing bone loss, osteoporosis and hip fractures and improvement of metabolic profile. That's like blood sugar and weight, at least in the women who started when they were less than 60 years old. And a reduction in breast cancer risk was noted in all age groups. Not an increase in breast cancer risk, a reduction in breast cancer risk in estrogen only at least. They found 19 fewer heart disease deaths and seven fewer stroke deaths per thousand Women in women using hormone replacement therapy for at least 10 years. And this is for women on estrogen therapy and especially topical here for healthy women in their 50s. Estrogen therapy decreases heart disease risk and all cause mortality. So, so many women even today. I got two more slides. So many women even today are being told they shouldn't go on hormone therapy because it's going to increase their risk for breast cancer. So here, 2014, over interpretation, misrepresentation of that 20 year old trial have damaged the health and well being of menopausal women by convincing them and their doctors that the risks of hormone therapy outweigh the benefits. I still today have women who come in and they come to see me because their doctor told them they shouldn't be on hormone therapy because it's going to increase their risk for breast cancer. So Here back to 2013, 2014, the totality of data, all these different studies converges to show a consistency, meaning they all say the same thing, that long term hormone replacement therapy decreases heart disease and decreases overall mortality compared with women who don't use hormone replacement therapy. So I'm going to stop sharing. But even today I see women coming into the office, some of them have been afraid of hormone therapy, so they're not on it. Sometimes they're told that they've been on it now for a while but they need to get off it because, you know, maybe now they're 60 and so they need to get off it because it's going to increase their risk for breast cancer. And so they go off it and then they're miserable. They have vaginal dryness, sex hurts, they lose all desire, they're not sleeping, which of course we've already said that's a risk factor all by itself. They can't remember why they walked in the room or where they left their car keys or what that person's name is. They got sticky notes everywhere. Look, I got sticky notes too. But they got sticky notes everywhere because they can't remember things. They got to write it all down and they feel kind of depressed, kind of flat, kind of, you know, just. They lose that zest for life. There are so many, many more symptoms of menopause and of hormone deficiency than hot flashes. You know, honestly, if hot flashes are the only thing that you have to deal with when you go through menopause, you'll get through it. They're annoying and sometimes they're bad. But the hot flashes are not the worst part. It's how it makes us feel. It's its effect on our brain and on our physical body. And it's very, very. Prof. And this fear of estrogen is so, so just permeating even doctors.

Yeah. But again, I want to reiterate that you are not talking about using synthetic hormones. And that that study, the findings of that study that really scared people were the effects that synthetic hormone has on the body. Right, right.

But all these other studies that I'm quoting here from 2013 and 2014, those studies were not necessarily on bioidentical hormones. So I don't recommend synthetic hormones. There's just why bioidentical hormones are widely available. There's just no need. I'm just speechless.

Yeah. Well, first of all, thank you for that brilliant explanation and presentation. It's very clear that we suffered a bad misconception which has had very ill effects on women for 20 years and has really resulted in a lot of suffering. Yes. So now we talked about it in the context of it doesn't cause breast cancer. Right. So now let's talk about the population of women that already have breast cancer. They carry a diagnosis, they've been diagnosed, they're through treatment. And treatment actually for most women has tremendous hormonal ramifications because most of the treatments for breast cancer, you know, I'll include myself in it for the surgery part of it is tremendously stressful. So when you're in a cortisol dominant state, which is what accompanies stressful times, your body is always going to preserve life over sexuality. So in a cortisol heavy state, you're not going to go on and make DHEA and testosterone and estrogen is just not happening because that is not the time to reproduce. So surgery puts people's hormones in the toilet. And then chemotherapy, certainly chemotherapy will shut down the ovarian. Even if someone was premenopausal, chemotherapy is going to shut down ovarian hormone production. And depending on how old you are, when you get chemotherapy, your ovaries may or may not come back and function afterwards. Then radiation doesn't really have an effect on that, but it's still the stress of that situation. And then many people are placed on hormone modulating drugs afterwards. They're placed on tamoxifen, which affects the estrogen receptor. They're placed on the aromatase inhibitors, which are only given to the postmenopausal population because they don't have an effect on ovarian production of estrogen. But we make a lot of peripheral estrogen after our ovaries shut down and that stops that. So women on these drugs are really miserable.

Yes. They don't feel good.

They don't feel good. And you take a disease that already interferes with people's sexuality and sense of self and then you give them this cocktail of drugs and their libido is in the toilet, their vagina feels horrible. And it's an awful place for these people to be because they fear for their life and then their life isn't even worth living. Right. So talk to me about your approach to the woman who's been treated for breast cancer and how you would help them to restore their health. Okay.

There's so much I get asked this question a lot. Like women will contact the office to say, I've had breast cancer. So I'm not really a candidate for hormone replacement therapy. But is there anything that you've got from. And the truth is there's so much that we've got. So I would say that one of the first things that we're going to do is to evaluate hormone levels. Because even if we're expecting, if you're menopausal and we're expecting that they're going to come back a little bit low, we want to know what's going on with your thyroid, with your cortisol, with the other hormones. And DHEA is a really important one because that's an anti aging hormone that your body still makes even after you go through menopause. And that's the one that we can use to make some estrogen and testosterone so that you can feel better. And cortisol is often the first kind of place where we start because cortisol of course is your stress hormone. And like you said, life is a priority. There's so much that we can do to optimize how hormone is, how cortisol is functioning. Because we don't want too much cortisol. We also don't want too little cortisol. And there's a circadian rhythm over the day and that circadian rhythm is actually really important. It's supposed to go up in the early hours of the morning so your eyes pop open and you're ready to jump out of bed and start your day. And then it's supposed to go down over the day so that at night you're relaxed and calm and you can fall asleep. And a lot for a lot of people that gets flipped around backwards. They don't get that nice burst of cortisol in the morning. So when their alarm clock goes off, they're pressing snooze. Maybe a couple of Times and, and even when they get them themselves out of bed, their brain's not fully turned on yet and they need to crawl over to the coffee pot to get a little jolt of caffeine, because caffeine raises your cortisol level so your brain can function and you can feel like a normal human. And then they kind of go through their day and they kind of get started and then the afternoon, a lot of people will get that crash and burn between 2, 3, 4 in the afternoon when they just need more caffeine or sugar or something to get them through to the end of the day. And then after supper, a lot of times people will kind of fall asleep on the couch when they're watching tv. Like they get tired early, but if they stay up late enough, now the cortisol spikes when it's supposed to go down. Now they can't fall asleep and they're wired and sometimes getting the best work of their day done at 10:00 at night.

Yeah, this is the wired and tired person.

The wired and tired. And that flipped around backwards where it's too low in the day and too high at night has been associated with breast cancer risk. So this circadian rhythm is really, really important. And there are lots of things that we can do to get your cortisol right again. So stress management is really healthy, is really helpful. Yoga, walking, breathing exercises, keeping a gratitude journal. There are so many things that we can do to help balance the effects of stress in our life and those are really important. And the truth is it's not even how much stress you have going on in your life. Although goodness, when you, you know, been through breast cancer, we know there's a lot, but it's how you allow the stress to affect you. And so if you can be doing some of these things to help bring some balance, it helps to protect you from the harmful aspects of cortisol on your skin, for sure.

And this is actually the practice of meditation. Right, Meditation. You know, we don't meditate to get good at meditation. We meditate to get good at life. And what meditation allows us to do is to build that skill set to decide which stressors am I going to internalize and allow to affect me and which stressors are we going to be able to say? Thank you for sharing. Yeah, right.

I love this hand thing. So one of the tips that I give my patients is if you can, this is the harp. If you can catch yourself ruminating over something like thinking negative thoughts, like stewing over something, if you can tell yourself to stop and put your hand out and say it out loud. Stop. Sometimes that can break the thought pattern and then you can purposefully turn your thoughts to something positive. Like, I'm looking forward to the weekend. It's a beautiful day today, you know. Or think of things that you're grateful.

Yeah, just say three. Three things you're grateful for. Three positive things.

It's easy. Let me say that differently. It's simple, but it's not always easy. You have to catch yourself doing it. But sometimes the palm and the stop can help you to switch. But bringing balance, managing stress is really powerful medicine and it's really important. So that would be a really good place to start. Would be.

I also like to encourage people to get outside as early as possible. So if you can let your feet hit the floor in the morning and somehow within five minutes get out into natural sunlight, I think that goes a long way in terms of setting that cortisol pattern in the right direction for the day.

Absolutely. And DHEA is another hormone. They're both made in your adrenal glands, as is adrenaline. So when your body is stressed and trying to squeeze out enough cortisol to kind of get you through the day, because cortisol is the one that helps you cope with stress, the resources all go to cortisol and the DHEA level goes down. So if we can help calm the cortisol, that can help the DHEA sort of naturally improve a little bit. And then we can use that to make just a little bit of estrogen and testosterone to feel better. Optimizing thyroid is really important too. There is an association between thyroid disease and breast cancer. So having healthy thyroid function is very important. And what we want to do there is measure the full thyroid panel, not just the screening test, which is not.

Just tsh, because TSH alone is not enough. And I love that you said that there is a connection between thyroid disease and breast cancer because I see it in almost 100% of my patients. And when you look to the data, they say no, there's no correlation and no increase. And anyone who has taken a biochemistry or physiology class knows that the effects that being hypothyroid have on the body are all risk factors for breast cancer. So how can it not be related? Right.

And there is no contraindication if your thyroid function, if you have an under functioning thyroid gland, there's no contraindication to being on thyroid replacement if you have a history of breast cancer. So, you know, let's optimize that. It's Good for mood, it's good for brain. Many of the similar symptoms that we see with menopausal hormone levels, they're also seen in hypothyroidism, low libido, dry skin, dry everything. Memory problems, mood issues, you know, low energy. Yes, all of it. Let's optimize thyroid, because why would you want to have two problems at the same time? And then another hormone that we would definitely look at is insulin, which is the one that regulates your blood sugar. I'm sure you guys have talked about how insulin is so. So very important for immune system function and problems with blood sugar. Insulin feeds cancer cell growth. So.

It'S a growth factor. Right, Right. It's our growth hormone. Right.

So we really want to optimize insulin because when. When we have too much insulin because of poor diet and sugar and starchy carbohydrates, it's very pro. Inflammatory. And the more inflamed we are that inflammation interferes with how our other hormones function. And so whatever. Little bit of estrogen, and it's actually.

Very tightly wound to cortisol. So people who are in elevated cortisol states because of stress, they are also going to be in elevated insulin states. And this, again, is the recipe for breast cancer.

So we want to look at all of these different hormones together and really optimize, work with as much as we can. For women who are menopausal and they have a history of breast cancer, it is still okay for us to give vaginal estrogen preparations in order to deal with the vaginal dryness. Urinary leakage. When you go through menopause, our tissues change. You know, the vaginal lining gets thinner and drier. It gets delicate, so it can tear and bleed. And it also increases your risk for developing urinary tract infections because, you know, the area is just not as plump and juicy as it used to be. So. And. And the.

So it thins out and it becomes vulnerable to. To bacteria.

Yeah. And we tend to develop stress, incontinence, leakage of urine, and that's something that just kind of progresses with age. And when it first starts, it's a nuisance, but it can get to be a really significant problem. And, you know, interestingly, this is something that I didn't even really know when I went through medical school. But a lot of times, families will help care for their loved one at home. But when the incontinence becomes so much of an issue in elderly people, the laundry, it's just such a burden. That's often the Breaking point where somebody ends up having to go into a personal care home. So anyway, none of us want to have to wear Depends. And these hormones can really, really make a very big difference, even for women with a history of breast cancer, where standard hormone replacement therapy may not be on the table for them. Using vaginal hormones in order to deal with this is something that most doctors are still okay with.

We're measuring cortisol, we're measuring dhea, we're measuring thyroid, we're measuring insulin. What about testosterone and estrogen? Are you looking at those levels?

I do. I would look at estrogen, progesterone, and testosterone. Testosterone in particular, is an interesting one. There is research that's been done by Dr. Rebecca Glaser. She's a breast surgeon, and she got tired of doing mastectomies all the time and wanted to look at what could she do to help prevent breast cancer. And also what could be done for. She had this whole cohort of her breast cancer patients. What she found is that. That women given testosterone, at least in her studies, did not have an increase in incidence of breast cancer recurrence. And so for some of my patients who are interested, I do give them testosterone replacement because it really helps keep your bones stronger. It helps with memory and mood and energy and libido and vaginal lubrication, and a lot of these things that women deal with when they go through menopause. It's still very controversial, but I am finding that more and more oncologists are okay with testosterone replacement, even if they're not okay with estrogen replacement.

Oh, can we just pause here for a second?

Anti proliferative at the.

Yeah. Most medical oncologists have no idea what the roles of hormones are. Most medical oncologists still think that estrogen causes breast cancer. As we have spoken about here today and looked at all the research, estrogen does not cause breast cancer. In fact, it's protective. Progesterone does not cause breast cancer. There were times in history when we used progesterone to treat breast cancer. The fact that medical oncologists don't object to giving testosterone when anyone who has taken a biochemistry course knows that testosterone is just converted in the body to estrogen. I mean, you know, that's not exactly an endorsement. I mean, it's a backdoor way of getting people estrogen. But I think that this is a great time for me to say that if you do not have active disease, I don't think anyone should suffer. My good friend Anna Kabeca told me that menopause is mandatory, but suffering is optional. And for all of the reasons that we spoke about today, estrogen and progesterone are protective. They do not cause breast cancer. And if you do not have active disease, there is no reason that I can see for you to not be on hormone replacement if it is otherwise appropriate. So if you're 70 and you have not been on hormone replacement for 20 years, that is not someone that I'm starting on hormone replacement. But if you are 50 and you've been, you've gone through treatment, you do not have breast cancer anymore. That is someone that I am absolutely considering putting on hormone replacement when, when the gut is healthy, when you are sleeping, when you are moving and exercising, when you have all of your stress management tools in place. So I just want to review because I think that this is a good time to end. I think, Steph, you can stop sharing your screen and let's just really review what Dr. Matthew talked about today because there was so much good stuff there. And it's a really important conversation to have. So the thing I need you to walk away from this talk with is that estrogen does not cause breast cancer. In fact, it is protective. The Women's Health Initiative results were premature, released without being verified. When they were verified, they were not true. And since then the paper has been retracted. Hormone replacement does not cause breast cancer. However, we need to think about it in the appropriate decade. So like I said before, the vast majority of the health deterioration happens in the first 10 years. So you really want to start people on hormone replacement. You really want to get started on hormone replacement and within those first 10 years, so presumably in your 50s and you can start checking hormone levels with your doctor in your late 40s to see where you are and see when you should transition onto hormone replacement. It is equally as important to know your cortisol levels and know that your cortisol levels are normal and optimize your thyroid health. And if you are not feeling well and you're on thyroid hormone replacement, and despite the fact that your doctor tells you that you're normal, this is not normal. And you need to have your TSH checked definitely. But that is just the beginning. You need to know your free T4, your free T3, your reverse T3, you need to know if you still have antibodies, if you still have antithyroid antibodies. Whatever is driving your thyroid disease is still there. And so the work needs to be in what is causing the symptoms, get to the root cause, figuring out why you have thyroid dysfunction and thus figuring out why you have breast cancer. But if you have been treated and you've optimized everything afterwards, there is no reason that I can see if you're an appropriate candidate in your 50s or if you were on hormone replacement already and you're in your 60s or 70s. There's no reason that I can see, once the disease is gone, not to be on hormone replacement. And people on hormone replacement will get breast cancer, just like people not on hormone replacement will get breast cancer. But it doesn't mean that the hormone replacement caused the breast cancer, because we see it just as much in people who are not on hormone replacement. In fact, in the last 20 years, the minority of people are on hormone replacement, not the majority. It has completely shifted because of the Women's Health Initiative. And for that reason, generations of women have suffered unnecessarily. So I hope that this talk today was helpful in clearing up this issue for you. I hope you go away from today knowing that estrogen does not cause breast cancer. There are certainly problems with taking oral estrogen, and we know that. We've known that for years. There is an increase in blood clots, so therefore heart attacks and strokes, but that can be completely avoided by using topical estrogen. I want to be clear. I am not in support of birth control pills because they do cause more problems than they solve. And if you have hormone issues and you're premenopausal and you think adding more hormones into that picture is going to solve the problem, I can assure you that it's not. Do whatever you can to avoid taking birth control pills, but know that there are postmenopausal hormone solutions available to you that are safe, that are effective, that will protect you against the symptoms of menopause, but also protect your heart, protect your brain, protect your bones, and do what they are meant to do. The fact is that we are living much longer than we ever historically lived, and we should be living well. We should be living better. And there's no reason to suffer unnecessarily. Stress management, having a meditation practice, practicing gratitude, breaking that cycle, balancing your cortisol, making sure that you're getting natural light first thing in the morning, then again midday, and watching the sunrise. All these things help to balance cortisol. And join us next week when we will talk to Dr. Valter Longo about fasting, intermittent fasting, and the fasting mimicking diet and the benefits around chemotherapy. It's Dr. Jenn Simmons. Bye for now.