Why You Need Estrogen as a Woman... Especially in Menopause!

Hi, I'm Dr. Tabitha, the gutsy gynecologist. I'm a triple board certified, OB, GYN and Functional Medicine physician. I've embraced the world of functional medicine and wellness through my own personal health journey. And I'm super excited to share my wisdom and unique perspective as it pertains to women's health. After caring for thousands of women, I've come to realize that your gut health determines your gyne health and your overall health. And it's a super gutsy thing for me to go against conventional gynecology practice to bring you the truth. No more band aid medicine, ladies. We're talking root cause resolution on this show. So if you're struggling with hormone imbalance, weight gain, period issues, anxiety, insomnia, you name it, then you've come to the right place. And I want to be your gutsy gynecologist. So welcome. Okay, let's get into it. Let's talk about the truth about estrogen. It's really important that you understand estrogen since it's the main driving hormone throughout your entire body that actually determines how you feel, how you function, how you look, how healthy you are, how quickly you age, all of it. Okay, we need to stop villainizing estrogen. Estrogen makes us who we are, and it's really, really an important hormone. It's the most important hormone for women. So let's talk about estrogen, you guys. Estrogen is imperative for you to grow into a healthy, strong young lady. It's not just for pregnancy. So it's really an important hormone when it comes to our overall health. And that's because we actually have estrogen receptors throughout our entire body. We have cells that. We have trillions of cells that make up all of our organs and our body. All these cells conglomerate and come together to work together to do these processes. And hormones, neurotransmitters, other chemical messengers, they float around the body, they go in the blood, and they go in between the tissues and the lymphatic system, in, in and out of fat cells. And they bind to receptors on cells. Receptors are like little doorways with locks on them. And the hormone acts like a key. It fits into the receptor, turns it opens it up, and changes how the cell is working. And so it's really important to have hormones to, to act like a key and send this signal. It's important for your receptors to work, you know, the lock, to be able to accept the key. And it's important for the cells or the house to, to be able to do its job. Once the hormone is inside. And so when we think of estrogen, estrogen is a growth hormone. It helps things grow. And growing is good if it's kept in check. Our cells are turning over and changing and regrowing and becoming new every single day of our life until we die. When we stop growing and stop renewing, that is when we die. So our skin cells, for example, turn over every 21 days or so. And if they stopped doing that, then we would have a buildup of skin. Our skin would get thicker, like a callus. That's where our cells aren't turning over properly. And so when it comes to estrogen, it needs to send the right signals. And progesterone is what keeps estrogen in check. So if estrogen is a growth hormone, progesterone is the antidote to that. It prevents things from overgrowing. So the perfect example is the lining inside the uterus. The uterus is actually a muscle made of myometrial cells. And that's why it can contract and squeeze and push the blood out. It can push the baby out because it's a muscle. Inside that muscle, it's shaped like a balloon. Inside of that muscle is a layer called the endometrium. And those cells are different from the mus cells. The endometrium grows every month in response to estrogen. And so, and then we ovulate, and we release an egg from the ovary in the act of ovulation. We make progesterone in this space called the corpus luteum. So if you don't ovulate, you probably aren't going to have much progesterone in your body that month. And so we don't have that hormone to balance estrogen. We continue to make estrogen until a few days before our next period when that level in production drop off. But that entire month, we are stimulating the endometrium to continue to grow thicker and thicker. And the idea is that your body is priming itself for that egg you released so that if it gets fertil fertilize, it can implant into the endometrium and turn into a viable pregnancy. So if you don't fertilize the egg and the body realize it never got pregnant, the estrogen and progesterone levels drop and your uterus releases that endometrial lining to be shed and bled and removed. So you don't only bleed blood, but you also bleed that endometrial cells that you grew that month. Your body's that incredible. It grows Brand new cells every single month. And then if you don't use them, your body sheds them out. And so you pass that tissue. If you continue to make excess estrogen that lin grow too thick in too much, that can even cause the myometrium, the muscle of the uterus, to grow. And that's called fibroids. Fibroids are the muscle of the uterus growing out of control. Or the tissue, the endometrium that's growing can backflow out the fallopian tubes and get into your pelvis. And those little endometrial implants land on your bowels, on your bladder, on the, the sides of your pelvis, everywhere inside your abdominal cavity. And that is called endometriosis. So it's just growth in the wrong place because you have unopposed estrogen. That's the medical term we call it, where you have estrogen, but you don't have progesterone to keep it in check. So really, estrogen is a beautiful, amazing, super important hormone, but it needs to be kept in check with progesterone. And when progesterone is off, that is when we start having problems. So as I mentioned at the beginning, we have estrogen receptors through our whole body. We have estrogen receptors in our stomach, in our brain cells, in our bones, in our skin. So if you have gone through menopause or you're in perimenopause, you might have noticed like, oh, my gosh, my face, it's coming down. It's not as plump and high as it used to be. Or my eyes don't work as well. I need reading glasses all of a sudden. Or my brain doesn't work as well. I can't remember things. I'm forgetting things. That is because you don't have enough estrogen to stimulate those tissues. That's what happens with osteoporosis. You don't have estrogen to protect those bones. So estrogen is actually really necessary and important for you to function and feel like yourself and be healthy. The most important piece is that you keep it in check with progesterone. This is where conventional gynecology is failing women. We don't understand the importance of progesterone, and I say we because I'm a conventionally trained ob gyn. Thankfully, I have had the push. Although it was uncomfortable to go and have more training. I became certified in functional medicine, certified in menopause medicine through the North American Menopause Menopause Society. I have done extra training through the Anti Aging Academy of Medicine I have done tons of training outside of my ob GYN training. So I understand the importance of progesterone. And I understand the difference between progesterone, which our body makes, and synthetic progestins, which is a little bit altered chemical form made by drug companies for birth control pills, Nupa rings, depo shots, IUDs and the like. There's a huge difference, you guys. So I just want to break down some basic estrogen facts and let's get into the idea that estrogen causes cancer, breast cancer. If estrogen caused breast cancer, then when estrogen levels are the highest, we would see the most breast cancer risk. Estrogen is your highest in your 20s and 30s, yet that is the lowest time to ever get breast cancer. The, the highest chance of you getting breast cancer is actually in your 80s. So your risk is about 1 in 26 in your lifetime. That risk slowly increases every decade. So in your 30s, there's a 0.4% chance of you getting breast cancer. In your 40s, it's 1.5%. This is according to all the studies. In your 50s, you have a 2.4% chance of breast cancer. In your 60s, it's 3.6%. In your 70s, it's 4%. It increases every decade that you live. In every decade that women live, they actually have less estrogen in their bodies, typically. So it's the depletion of estrogen, the lack of it in your body, that increases your risk. Yes. The Women's Health Initiative study that came out in 2002 and the media ran wild with confused us. That study was halted abruptly, just as quickly as it was started. And they stopped it because there was one extra breast cancer case out of the whole group. Unfortunately, it turns out it was the estrogen plus progestin group. It wasn't the estrogen alone group. So in the estrogen plus progestin group, there was one extra breast cancer case. And so the study was halted and the media ran wild with it and said estrogen causes breast cancer because people don't understand how to read studies or interpret studies. And let me just tell you, we have done women a huge Disservice because over 70% of the population were taken off their hormone replacement therapy overnight. Back in 2002, like, it was just patients panicked, doctors panicked, everyone panicked. So women went off their hormone replacement therapy. This is 21 years ago. You would think, let's use some basic common sense here. You would think if 70% of the population stopped using their estrogen and their hormone replacement therapy 21 years ago that we would see a dramatic decrease in breast cancer. Correct. Yet we have not. The rate is still there. It hasn't changed with HRT use, with estrogen use, it's because it's not a factor in that way. Do you understand? Like we have lost all common sense. We really have. So we should have seen the rate of breast cancer decrease over the past 20 years, yet we have not. And the bigger thing is that the overwhelming majority of women with breast cancer diagnoses have not taken hrt. They have not been on hormone replacement therapy after menopause. Think about it. Why are we saying estrogen causes cancer? We are confused. We don't understand. Okay, so there have been countless other studies that have debunked this. The Nurses Health Study, there was a study with bra gene mutations where women had their ovaries removed, went on estrogen replacement therapy alone, and it actually had a decreased risk of breast cancer in that group of women, not an increased risk. So in 2017, the lead researcher from the Women's Health Initiative study said that they were going, quote, unquote, were going for high impact to change the thinking of HRT and show that it is harmful, unquote. The entire point of doing studies is that you're supposed to be non biased. You're supposed to go in there into a study with a hypothesis and try to prove it wrong. You're not supposed to set up a study that you try to prove something right that puts a bias on the study and changes the outcome. So this study was biased. The other issue is that the average age woman of the study was 63 years old. She was more than a decade out of menopause. Her body had gone over 10 years without any kind of hormones. And then she was put on synthetic hormones, conjugated equine estrogen, which is made from horse urine and synthetic progestins. So nothing bioidentical. It's not the same chemicals that our body makes. 35% of the women in that study were overweight, 34% were obese, 36 had hypertension, they had cardiovascular disease with high blood pressure, and half were past or current smokers. So can you understand, like, this is not your average healthy woman in perimenopause and early menopause. So the study that we are using to say it's not safe for you to go on hormones doesn't even represent you as a woman. That is not you, most likely. So I want you to understand that when your ob GYN is telling you that There are risks to hormone replacement therapy. They most likely don't apply to you. They apply to women in their 60s who are smokers, who are obese with cardiovascular disease already. So if you are young and healthy and eating a well balanced diet, you're moving your body, you're not drinking alcohol every day, you're not smoking, you do not have those risks. What are the risks? They were blood clots and stroke from oral estrogen. So an estrogen pill. And what happens is the estrogen pill, the estrogen made from horse urine, not the same kind of estradiol that we make conjugated equine estrogen. When it gets absorbed in your gut, the bacteria actually turn it into estrone and then it gets absorbed and it has to go through this first pass liver effect. And that causes you to have more 4 hydroxy estrone. And that kind of estrone can cause damage to the DNA inside the cells and it causes you to increase your clotting factor production from your liver. So it increases your risk of blood clot and stroke. That is with oral conjugated equine estrogen, otherwise known as Premarin. If you do bioidentical hormone replacement therapy, estradiol with a topical transdermal solution of a cream, a pellet, a patch, it doesn't have that first pass effect. It doesn't get turned into estrone, your gut and liver, the way conjugated equine estrogen tablets do. There is an estradiol tablet, so that is technically bioidentical because it's the same compound, but it still has that risk of blood clot and stroke. So we did learn some things from this study. We learned that older women who already have comorbidities, they have cardiovascular disease, they have chronic inflammation from being smokers, from drinking alcohol, from being obese, they do have risks to going on hormone replacement therapy 10 years plus past menopause. So that's what we learned. We also learned synthetic progestins are the culprit. Unfortunately, this information continues to be suppressed because it is in all the birth control that is out there. And there are some very important people who would not want that to come to light. So I'm just going to be super honest right now. It is your job to understand what you're putting in your body. And I, I believe synthetic progestins are way more harmful than even the conjugated equine estrogen. So I would recommend staying away from Prempro, staying away from any of those North End drone. We'll just have to make a list because they have such crazy names. You'd be like, what? What if it's not progesterone? Then it's a synthetic progestin. And that's where the problems lie. That's why most women don't feel good on birth control pills. Most women have anxiety or depression. Irrit, regular bleeding, weight gain. Those are all side effects of the synthetic progestins. So I hope that you're starting to understand that we have villainized estrogen. We shouldn't. Estrogen keeps us young and healthy. It makes us who we are. It's wonderful. And I personally love seeing women go on bioidentical hormone replacement therapy after menopause or during the transition so that you don't have to suffer unnecessarily. As soon as your body stops making those same levels of estrogen, your risk of diseases starts to increase. Your risk of diabetes, cardiovascular disease, heart attack, which, by the way, is the leading cause of death for women after menopause. Heart disease. Because we have estrogen receptors in our arteries. Our arteries are smooth muscles. They contract and they move the blood through our body. And they're very elastic and stretchy because they need to be able to handle different pressures from the heart pumping the blood throughout the body, depending on if you're running and exercising or if you're sitting quietly or if you're angry, all these things. And so our arteries are very elastic and pliable, and they can handle the change in the pressures. And a huge reason that is so is because of estrogen, the estrogen binding to the receptors on the, the cells of the arteries and making them that way. When you go into menopause and you no longer have that estrogen stimulating your, your arteries and your heart muscle, your blood pressure starts to go up and your arteries become stiff. They turn into like pipes, and they don't have that ability to handle those changes anymore. And so your heart and your blood have to pump harder to get through that rigid tube because there's no longer any squeezing or help from the arteries. So it's very common to, to develop hypertension or chronic elevated blood pressure after menopause. Then we see cardiomyopathies like your heart muscle actually grows and increases because it can't handle the stress of having to work harder and pump harder. A lot of us lose our ability to exercise. We no longer have that tolerance to do aerobic activity and get our heart rate up because we don't have estrogen helping our arteries change, how they respond to our blood pressure. Changes. We also have an elevation in cholesterol because we're no longer using it to make our hormones. So all these things start to shift. We lose our cellular sensitivity to insulin. All of a sudden our risk of diabetes increases. And then we gain weight. Okay, here's something really important for you to understand. Your body is not trying to sabotage you. Your body is not stupid. Your body was innately created with intelligence and it knows exactly what it's doing. And it's always trying to be in balance, despite all the stuff coming at it from the outside world or the inner brain. And so when your ovaries are done making estrogen and they are no longer producing estrogen every month, that's what happens in menopause. Your ovaries stop producing and your estrogen levels stay low forever. The rest of your life, your body increases the amount of fat cells. Why does it do that? Why do we gain weight with menopause? Because our fat cells can make estrogen, you guys. It's incredible. It's such a cool thing. So our body takes testosterone and makes estrogen in our fat cells. So this I found really fascinating. You know, a decade more ago, when I was in medical practice, I noticed that my obese patients didn't have any menopausal symptoms when they went through menopause or they had very little. They almost always would say, oh, it's no big deal. I didn't really have hot flashes or night sweatshirts. I didn't really notice. And I thought, wow, isn't that interesting? Why do the very small underweight women seem to have more menopausal symptoms? Like it was very common for 110 pound white woman to have way more hot flashes and night sweatshirts than it was for a 200 pound woman, especially African American women. And so it turns out that it's because they're making estrone in their fat cells. And once I really started to study the physiology of the menopausal and perimenopausal woman and really see the beautiful innate intelligence of our body, I started to respect it way, way more. We have it all backwards. We think that our body is continuing to fail us and that getting older means the body is going to fall apart and fail us. Because that is what the medical system has trained us to believe. I believed it too. And then I woke up and I was like, wait a second. God doesn't make bodies that fail us. He makes bodies that can endure and survive until your very last day. The biggest thing I think that made me figure that out was being a surgeon, you guys. So as a surgeon, think about me going in and doing a C section. I cut through your skin, I cut through the fat, I cut through the fascia, I cut through the muscle of the uterus, I extract the baby, and then I use suture, which looks like big fish line, and I sew those big cut holes back together. That uterus is. Still has a huge gaping hole in it. Your skin still has a huge gaping hole, but the suture is keeping the two ends approximated. Okay. And hopefully until your body can do the innate, amazing, intelligent thing of healing itself, your uterus muscles start to grow back together. Your fascia, which looks like a weaved basket of, of tissue, grows back together. Your skin grows back together. I didn't do that as a surgeon. I just put the sutures in there to re approximate the tissue. But we're trained as surgeons to believe that we actually do the fixing and the healing. But it's not. It's God. He created your body to heal. So I want you to really think about this, think about what's happening inside your body. And I, I invite you to just shift the way that you've been believing and thinking about your body. And I invite you to believe that your body is capable of complete transformation and healing. I invite you to believe that you don't have to live with autoimmune conditions. You don't have to live with all these symptoms. You don't have to have chronic back pain, you don't have to have chronic gut issues, that you can have a regular bowel movement every day, that you can feel joy and not be depressed, like whatever your ailment is, you don't have to live that way. I promise you, I am living proof. My patients are living proof. It's a work in progress. There's always something going on. But we need to give our body love and grace because it's doing the best that it can with all of the bad things coming at it all day long that's happening to it. Start thanking God for your estrogen. Start appreciating the fact that your body makes estrogen or, hello, thank God that you can get estrogen transdermally after your body's no longer making it, and that we understand all these advances and that you found me like, I am so grateful for my hormone replacement therapy because I went into menopause too early. I shouldn't have gone into it so early, but I was completely stressed out and I wasn't honoring my body. And so that's what happens. And you deserve to live a full, amazing life. And having your hormones balanced helps you do that. Okay, so I just debunked a crap ton of stuff today. I hope that you are feeling empowered and. And less confused. So whatever you're still confused about or whatever you're still hearing bad information about, I want to know, like, DM me, email me, you know, shoot me a video on Instagram and tag me, whatever you have to do. I want to hear what you're thinking about this topic because we have to change the narrative. We have to change the conversation. We're being fed lies and it ends now. Okay? So I love you, I want the best for you. But I need you to take action. I need you to get into action. Be your own advocate, keep reading, keep listening, keep researching, and then share it with every woman you know. Because this is a sisterhood, not a competition. We are in it for each other. We need to be there for each other, especially during these times of change that we're all going through. And I would be so honored if you would hit the subscribe button if you would leave me a five star review if this resonated with you. Obviously, if it didn't, I don't want you to do that. I want you to just tell me exactly what you need from me and I'll keep making it happen. So I love you. Go have an amazing week and know that your body is working for you. Keep listening to it, keep giving it love, and life can just get better and better.