3 Warning Signs You Need Hormone Replacement Therapy Over 40

If you're dealing with menopause symptoms, listen up. Misinformation could be making you miserable, and worse than that, potentially hurting your health. In this video, I'm going to refute the misinformation and give you the information you need to walk into your doctor informed so that you can make the best decision for yourself and your overall health. All right, so this misinformation, it all started with the Women's Health Initiative. What went wrong? Well, first of all, the Women's Health Initiative used a specific combination of hormone therapy called Prempro, which consisted of synthetic estrogen and progestin. Now, some critics argue that the results might not apply to other forms of HRT, such as estrogen-only therapy. And here's the other issue: they used oral estrogen, and oral estrogen has been shown to be problematic and isn't used by most of the functional medicine doctors I know. In fact, any of them— they do patches or shots or cream or troches. So let's get into the study. This was 2002 when this was abruptly halted because the preliminary data showed an increased risk of breast cancer amongst women taking a combination of estrogen and progestin as part of their HRT regimen. So this decision to stop the study early due to safety concerns was like this huge media outburst and caused all this alarm among women using HRT. And understandably, it's like increase in breast cancer of 26%, except when you dig into the research of this 26%, it was a relative risk increase, which means it was a percentage increase in the existing risk rather than the absolute risk increase. And when it was unpacked, you know what it turned out to be? That there was one more breast cancer case in the HRT group versus the non-HRT group. One. And when they analyzed it further, there was a bit of a more nuanced picture. While there was an increase in relative risk of breast cancer associated with HRT, that one person, the absolute risk was relatively small. Critics estimated that for every 10,000 women taking combination HRT for a year, there'd be an additional 8 cases of breast cancer. A couple other things that went on: the study evaluated the effects of HRT over a really short period, about 5 years, which really didn't give it much time to assess this thing accurately. And the bigger important thing was The participants in the study were older women. The average age was 63 years old, which I, I would not say is old, but the important thing was this is when they were starting HRT, and that means that they'd lost a lot of years of protection that HRT could have given. They were likely off of hormones for 10 years. So what was that doing at the time for their cardiovascular system, their bone health, their brain health? And the study and the way it was reported in the media, basically, it basically took out a generation of women. And worse than that, it still seems to live on. So hopefully you'll look at this, and I did a Well Beyond 40 podcast really unpacking the whole WHI study and all of the issues with it, including the way that kind of they lied with statistics, the media blew it up, and the fact that they started, they used synthetics, and they started with women 10 years postmenopausal. Like, there are just a lot of issues with it. And, you know, I had one woman DM me and she goes, I'm 65 and is it too late for me? And I feel like I'm really lost. And then another woman who came up to me, I was speaking at an event, and she goes, you know, I'm done doing everything that you talk about. I'm exercising, lifting heavy things, I'm eating protein first, and I'm eating ideal amounts of protein, I'm doing good recovery, I'm sleeping well, I'm managing stress, I cannot lose the weight. Turns out lower estrogen— and of course you go through menopause and your estrogen is basically very, very, very low. You're producing what you can produce through your adrenals, but your estrogen's very low, right? Estrogen's needed to burn fat, estrogen's needed to build muscle, and estrogen's needed for a good healthy metabolism. In fact, it's estimated that when you dump your, your estrogen, you lower your metabolism by about 200 calories a day. So this woman comes in, she goes, I can't lose the weight no matter what I try. And she goes, I don't want to go on hormones, I want to do this naturally. And I'm like, well, but hormones are natural when you think about this, because you're giving your body what it had naturally. And ideally, when you want to go on hormone replacement therapy, when you start having the symptoms. But ideally, you want to do it in conjunction with doing everything you can through diet and lifestyle so that you need the least amount possible and you have the least impact, the least lowering possible. So we're going to talk about all of that. But first of all, like, how do you know where you're at? Because you can test, but I want you to remember that testing is a moment in time. It's a snapshot, and you are a movie. Your hormones are a movie, especially as you're going through and you're perimenopause. Your hormones are fluctuating a lot, especially estrogen. Progesterone's declining, testosterone's declining, but estrogen is going like this, and then it goes boop. So there's also more to it than just testing. There's also beyond your levels, there's also your hormone receptor sensitivity and your hormone receptor density. So there's a lot here to look at. For low estrogen, you'll start to get those hot flashes, the night sweats, dry skin, dry vaginal dryness, irritability. Best way I could— I remember feeling like I just wanted to unzip my skin and leave and come back later. Your libido goes in the tank, you're tired, you're your skin and hair start to get weird, dry, and thin. You get memory problems, like you're walking into a room and you have brain fog, you can't remember why you were there, you can't seem to concentrate. And this is where you start to get joint pain, weight gain. Again, estrogen, as it goes down, your metabolism starts to go down. The things that I remember with this are, number one, I couldn't recover from the gym, so I had more inflammation. In fact, one of the things we start to see is that cholesterol goes up, inflammation goes up, you start to— insulin starts to go up. I had night sweats, my gums started to bleed, and I started to gain weight around my waist. For testosterone, um, some of the things that you'll start to feel— kind of some of them are similar to estrogen, like your fatigue and your mood changes and your libido is going down. But the big things here: libido, muscle weakness, inability to put on muscle. Um, you'll have a lot of stuff there too with memory. And similar to estrogen, higher risk of osteoporosis, and bone fractures with the role of testosterone needed for bone density maintenance. And of course, just kind of reduced sensation when you're having sex. Progesterone— and when I think of progesterone, and this is the first one that starts to decline in most of us, one of the biggest things that it does is anxiety and sleep. So those are the ones you're really going to start to see, along with irregular cycles and heavier bleeds. But things— bigger PMS stuff like mood swings, irritability, breast tenderness, bloating. You might get miscarriages or infertility. Biggest one of all though, insomnia. And quite often, as this one starts to go, if you just replace with a little bit of progesterone, you start to sleep well as well. Another one that can come up here is GI symptoms. You'll get constipated, you might get bloated. So those are all things that you'll start to see with progesterone. And again, I want you to start to connect the dots here. Oh, one other important one with progesterone that's common is headaches. And migraines. And so if you're someone who's never had headaches or migraines, then all of a sudden you do, this is another big sign. And again, these are all important because lab testing is a snapshot, and you are going to want to put that together with symptoms when you go talk to your doctor. Now here's the thing— don't wait till you're miserable with symptoms to go on HRT. You're going to go on HRTs because you're going to be working with your functional medicine doctor, you're going to be working with your labs and with your symptoms. And you want to come in and do— you're going to do your own work too, because you can't balance hormones in isolation, right? And really what's important here is that you're doing this along with diet and lifestyle. Now, whichever way you decide to go, whether you decide to try to do this with, um, you know, supplements, or you decide to go bioidentical, there's other things that are super important. One of them being thyroid health. Because if your thyroid's not working well, it's going to be really hard for you to balance your hormones. So one of the signs— you're going to want to get a full thyroid panel, and I've done videos on thyroid health— full thyroid panel including TSH, free T3 and T4, thyroid antibodies. But some signs that your thyroid's not working really well: fatigue, weight gain, cold, constipated, your LDL cholesterol goes up, you start to lose the outer third of your eyebrows, your skin's got a little yellow tinge to it. So those are just some common ones. You might get a little bit depressed, your hair might start falling out. The other one that's important here is your adrenal health. And most of the functional medicine doctors I know do a full thyroid workup as they're starting to look at working with someone on putting them on HRT, and they do a full adrenal workup. And what they'll do there is they'll do an adrenal salivary index. That's a salivary test where they have you spit 4 times a day to see your cortisol rhythm. As we start to go into menopause, as ovaries start to shut down and not produce estrogen, we're going to rely on our adrenal glands to estrogen, testosterone, DHEA, and you'll also use your body fat to do that. Ideally, you'd rather do it through your adrenals and through hormone replacement therapy. Another thing that starts to happen during this time is our cortisol goes up and we become more insulin resistant. So now we have higher blood sugar and again more belly fat. Probably notice some of these things. Now, the things that you can also do to support this in diet— eating some phytoestrogen-rich food. This could be sesame seeds, flax seeds, chickpeas. If you can handle soy and don't have thyroid issues, soy and soy isoflavones can work here. The other thing you're going to want to include in here are high-fiber foods. Number one, fiber supports a healthy gut microbiome, which of course is mission critical for hormone balance. And the other thing that fiber does is helps with estrogen metabolism, because when you are metabolizing estrogen, you have to be able to eliminate bad and excess estrogen. So that's super important. And of course, remember If you're doing fiber, you want to have the water with it too, so make sure you're staying well hydrated. Now, in terms of supplements, there are some different supplements that can help with hormone balance during this time, but I'm going to look at things that more help with detoxification. One of the things I really like here is something called DIM. This supports hormone balance during HRT by aiding in estrogen metabolism and converting estrogen into its less potent forms, which reduce the risk of estrogen dominance. And research shows that DIM could have a protective effect on breast tissue by promoting healthy, healthy estrogen metabolism. It's one of those supplements that's considered safe for most people, and it's often recommended. I think if you're taking estrogen, this is definitely one that you want to take alongside it. Now, one that I didn't know before, and it was actually crazy because this happened to me, is ginseng. Well, ginseng, first of all, is going to help the body adapt to stress. It's going to help the body maintain hormone balance. It supports overall, overall well-being. It's— and these are all the things they taught us when we were at the Ginseng Museum in Seoul. They were like, it boosts energy and vitality, it helps your physical and mental performance, it, it's great for, uh, reducing fatigue. I'm like, okay, cool. They said it improved cognitive function and it improved memory, improved libido. So all of those things sounded great. I started taking it. I didn't expect it to have the impact where I needed less hormone replacement therapy because of it. So it also is a great antioxidant, so it can protect your cells as well. But again, where I'm looking at it here is using an adaptogen like ginseng— ashwagandha is another one that can help improve hormone receptor sensitivity— because wouldn't it be cool if you can use the least amount of these hormones that you need to get the positive result? Another one that supports hormone replacement therapy is vitamin D3. Is going to be helpful for maintaining bone density, for reducing osteoporosis risk. It helps with mood regulation, it helps with hormonal balance and immune function. And also what's super important is also important for insulin sensitivity. And one of the things that happens as we go through menopause is we become more insulin resistant. Vitamin D can also lower the risk of postmenopausal diseases like cardiovascular disease and it contributes to overall well-being and health. It's crucial to monitor vitamin D levels because you don't want to have too much either, because you store fat-soluble vitamins. Although I don't see most people having too much, I see most people not even close to where they need to be. You want to take your vitamin D3 with K, and generally it's, um, K1 and K2, because both vitamin D and K are involved in the regulation of calcium. Where vitamin D is going to help you absorb calcium, from the diet. K makes sure it goes to the right places, like your bones and your teeth, rather than in your soft tissue, like your arteries. Now, one thing we know about estrogen therapy is that it can have cardiovascular protective effects. There is a possibility with risk of blood clots in some women, and that's another thing that vitamin K can play a role in here, is it prevents arterial calcification and helps maintain vascular health. Which could mitigate some of the potential adverse cardiovascular effects associated with HRT. Plus, some research suggests that estrogen may increase the synthesis of vitamin K-dependent proteins involved in bone and vascular health. So bottom line is you want to have HRT with vitamin D with vitamin K to optimize the effects of estrogen therapy on bone metabolism and cardiovascular function. Now, one other one that you probably haven't heard about is something called geranylgeranol. It may stimulate osteoblast activity. These are the cells that are responsible for bone formation, and it may inhibit osteoclast activity. Those are the cells responsible for bone resorption. And when you support bone reformation and you reduce bone breakdown, then you help mitigate bone loss and osteoporosis. GG also can reduce oxidative damage and inflammation and potentially alleviate hot flashes and mood swings and joint pain as well. Plus, geranal, geranal may have beneficial effects on cardiovascular health. So it can help with your body making CoQ10. If so, it helps promote vascular function. It can help reduce arterial stiffness, and it can also inhibit the development of atherosclerosis. So I take a product every day that has something called annatto tocotrienols. That's a specific form of vitamin E. And GG, and it's one of the things that I do for heart and bone health. And I'm going to link to that in the show notes as well. Don't buy into the fear of the misinformation. You know, there's no reason to be miserable in menopause. Honestly, this can be the best time of your life. I just interviewed Dr. Lisa Mosconi for Well Beyond 40 who talks about the menopause brain, and she says, you know, a brain— postmenopausal brain is actually a way happier brain So let's live into that. And in this next video, I'm going to share 6 ways that you can master menopause and feel better than ever.