00:02
Dr. Ade
Welcome to the Modern midlife Collective podcast. The place where we get unapologetically real about thriving in midlife health, hormones, and everything in between.
00:12
Dr. Jillian
I'm Dr. Jillian.
00:13
Dr. Ade
And I'm Dr. Aday.
00:14
Dr. Jillian
Together, we're your guides to navigating this powerful season with confidence, strength, and the wisdom you deserve. Welcome back to the Modern midlife collective. I'm Dr. Jillian Woodruff. I'm a board certified gynecologist, cosmetic gynecology surgeon, sexual medicine expert, and a nationally certified menopause provider.
00:37
Dr. Ade
And I'm Dr. Aday, doctor of nursing practice, board certified family nurse practitioner, functional medicine expert, and metabolic health specialist.
00:45
Dr. Jillian
Today's episode is all about setting the record straight as menopause makes its way into the mainstream. We're seeing more buzz, but unfortunately there is still a lot of misinformation, misunderstandings, and just all around things being spread that aren't true. So let's talk a little bit about what some of these myths are and let's see if we can debunk them today.
01:09
Dr. Ade
Absolutely. We're dedicating this episode to getting rid of those Is it true? Is it not true? And most talk about those persistent symptoms and maybe myths that keep you confused and not maybe want to even seek treatment. So let's dive in. Let's start with one big one that comes up almost all the time, almost through every conversation. Sometimes when people come into the clinic, this is one of the first things I hear about. So myth number one is that estrogen causes breast cancer. Dr. Jill, you take this.
01:39
Dr. Jillian
This is one of the most damaging and misunderstood myths out there, in my opinion. So their research is based on a study called the Women's Health Initiative, which was released in 2002 by Mainstream Media and not actually released by the investigators. And then it was released with these headlines saying, estrogen causes cancer. Estrogen causes breast cancer specifically. And then the study was halted, and it never went back into why the study was being done and what the study was actually looking at, which was not looking at hormones in general and relieving menopausal symptoms. They were looking to see at what hormones could do, specifically estrogen and progesterone, on risk factors or disease states. And the people that were enrolled in these studies, many of which already had risk factors for disease or already had chronic disease already.
02:42
Dr. Jillian
So some of the issues that happened to these women, they just took them out of the study or attributed it to hormones where they were already on certain disease processes. But specifically about breast cancer. No, estrogen does not cause breast cancer. Estrogen actually in the studies, in the original studies, was found to be protective against breast cancer. So in the original studies, when they looked at women getting estrogen only, now, these would have only been women that didn't have a uterus, because estrogen can cause an overgrowth of the lining of the uterus. So in those who have a uterus, they would be treated with estrogen and something to prevent that overgrowth, like progesterone. So in those that didn't have a uterus, they were on estrogen only, and they were shown to have actually lower risks of breast cancer. So that's important to note, right?
03:37
Dr. Jillian
Especially with the idea that estrogen itself causes breast cancer. Now, when they looked at the women who were taking estrogen and progesterone, another important thing to know is that we cannot generalize findings from a study to all situations. The progesterone that they used in the study was a synthetic progesterone. But the important thing to note is that it's actually much more potent than the types of progesterone that we use today. We do use some synthetic progesterones. We also use bioidentical progesterone. Nonetheless, the things that we use for hormone replacement are not the same type of progesterone that they used in this study. And also, the estrogen that many people use may be different. They used only one type.
04:24
Dr. Jillian
They were using Premarin, and also they were using the mode of hormones, was taking Premarin by mouth, like as a pill, which also may be different than how many people take their hormones today. But the scary thing is they used the absolute risk and scared people saying that the risk was twice the normal. So let's say if somebody had a risk of every of 25% of getting breast cancer, well, if they took estrogen and progesterone, it increased to 50%. Unfortunately, absolute risk and relative risk. You need to know what you're dealing with. Absolute risk is just the number, but relative to what is important to know. So the relative risk, this percent relative to this other percent or this group relative to this other group. So this group had twice the risk of breast cancer than this other group. That's the relative risk.
05:21
Dr. Jillian
The absolute risk would be important to know, and in this situation could have really relieved many people's fears, because the risk of cancer in the group that did not have estrogen or progesterone, let's see, it was about 4 in 10,000 women per year. Whereas in the group where they had estrogen, progesterone was 8 in 10,000 women per year. So you can see how it is double the risk. We went from four to eight. However, when you're making your decision on if this is right for you, would that be a significant finding? To me, it would not be a significant finding that went from 4 in 10,000 to 8 in 10,000. And also I would want to think about what medications were used, how they were used, and none of these things were shared at the time of the study.
06:17
Dr. Jillian
All they did was scare people and then continue to disperse this fear, which I think was in the control of women. They continued to disperse this, and then decades later, people had missed out on the awesome power of hormones. Sorry if that was the long answer, but it's just so important to understand this myth that we're not increasing your risk. Now. There's caveats to it. So I don't know if you want me to go into that right now or not.
06:47
Dr. Ade
No, I don't think it was long at all. In fact, I think it's important that we really break it down and be very. And let people be very aware that unfortunately there was and over generalization, if you will, to, you know, this, what the results showed and how they generalized it to the whole population of women as we talked about in other episodes, right. You can start to have symptoms at a much younger age. So looking at the population that was studied and how broad, you know, you can have, you know. So unfortunately, the people who could really benefit from this did not, you know, people were told stop taking them. They caused cancer. So I think you did a great job in really breaking out down the relative versus absolute risk.
07:30
Dr. Ade
The study, the kind of hormones that were used, all of that makes a.
07:34
Dr. Jillian
Lot of sense right now. It is important to know, and we definitely want to make sure that women are getting their screening because overall, there is a about 12 to 15% risk in the general population for breast cancer. So this isn't even taking into account your family history or your specific situation, but in General, it's about 12 to 15%. So in practicing good medicine, we do want to make sure that someone doesn't have a breast cancer before they begin hormones, because some breast cancers are sensitive to hormones. So like we discussed before, you have hormone receptors all over your body. And healthy cells that replicate and grow have receptors to estrogen. That's a very typical and normal faint. So unfortunately, a breast cancer cell is no different. Many breast cancer cells have hormone receptors for estrogen. So how can we kill cells?
08:38
Dr. Jillian
How can we make things not survive and do well by taking away things that help it to prosper. And so that would be taking away estrogen from that breast cancer cell. Also, what's going to happen to other portions or parts of our body? Yes, they may suffer as well. So the fact that a cell has an estrogen receptor is not something that's novel or new or special for breast cancer and hormones. This is a very typical thing to have these cells. Now you may have some cells that aren't sensitive to hormone, and that's fine. Those may be even a little more difficult to treat because you can't just take something away from it.
09:19
Dr. Jillian
So that is the reason why I get screening, and I know you do too, why we screen people to make sure that they do not have any signs of a breast cancer, because we know that it's very typical for cells that are normal to have receptors to estrogen. And so we don't want to giving you hormones if you have something that would be treated by taking hormones away.
09:44
Dr. Ade
So the take home message for women, if you're listening, when you go to a provider and they're telling you that they want a mammogram before they start you on a hormone replacement, you are going to a very good provider. And again, we're not saying that hormones cause cancer. That just like Dr. Jill says, if there's something that is very sensitive to hormones, you don't want to make it worse or grow. Right. Because we're giving you something that's feeding the cancer. So it's very important before you start any kind of hormone replacement to make sure that you're getting the screens that you need so that you're staying healthy. So thank you so much for clarifying that. So we're gonna move on to myth number two. You can't get pregnant in perimenopause. This is really exciting. Let's talk about that.
10:25
Dr. Jillian
Yes, that is also wrong. You certainly can get pregnant in perimenopause. You may not even know that you're in perimenopause, or you may think that you're in menopause and you could get pregnant. So while fertility declines, ovulation can still occur. It just may not be occurring at your regular monthly intervals as it had in the past about every 28 days. And so it can be very unpredictable and sporadic, which one hand increases your risk because you do not know when your fertile days are. And so I have seen many surprise pregnancies at midlife. And a surprise, you know, it may end up being a Good surprise. But it also can really reshuffle families and future plans.
11:12
Dr. Jillian
So even if you are having your period irregularly, you do need some sort of protection from pregnancy if you do not want to be pregnant during this time. And you should also keep in mind that should you get pregnant during this time, it does increase your risk for not just chromosomal disorders or differences, mutations in your fetus, but also increased risk of pregnancy complications and delivery complications. So you want to keep that in mind. One of the things that can happen when you are ovulating is that you could have this double ovulation. It's kind of because your hormone levels fluctuate so much in perimenopause that sometimes it's trying to get that ovulation together and it can't. And then maybe it ekes out an ovulation, and then a little bit later, you can have a double ovulation in the same cycle.
12:06
Dr. Jillian
That is a completely abnormal thing that happens to women in perimenopause, but give you two chances to get pregnant. So be careful if you do not want to have a pregnancy.
12:18
Dr. Ade
Noted. So again, ladies, contraception is still necessary until you have com basically gone about 12 months, no, 12 months or more without a period where you're in menopause. And at that point, of course, we know that the likelihood of that happening is probably very low. Myth number three, testosterone is just for men. So this is something that I've been talking a whole lot about with, you know, on social media as well as in clinic as well, because it's that assumption that testosterone is that man hormone that makes you bulky and have a hoarse voice and grow hair. But we're learning more that women do produce testosterone. And like you talked about before, we fat receptors everywhere. So we women need it too, just like men do.
13:03
Dr. Ade
Maybe not as much as they do, but we do need it for a lot of the functions that we have, like our libido, you know, energy and mental clarity. And we know that it starts to slowly decline. In your 30s. Yes, ladies, even in your 30s. It might not become, you know, make you feel as masculine, but it's one of the things that women will say is they just don't have that get up and go. They feel like they'd get up and got up and left them, they're crashing midday. They're leaning to lean on caffeine to get going.
13:33
Dr. Ade
And of course, we know that there's other lifestyle things that might add to that, but testosterone is super important oftentimes, you know, in the clinic, I'll do a body composition for women who are wanting to lose weight, and we'll find that their muscle mass is so low. I had an example the other day when I said to a lady, I said, you know, when a woman comes in with a weight of 130 and they're both 130, a woman is a 50% body fat. And then you have one that's 20% body fat, who do you think is the most healthier out of the two? It's the one with the more muscle mass and less fat. So if you're sitting at home thinking, wait, I believe some of these met before, you're not alone. That's why we're here.
14:13
Dr. Jillian
Yes. We want you to feel seen, heard, understood, supported. And not just with medications, but with the power of knowledge and with the ability that you can take the knowledge that you gain and share that with those that you love. The more we talk about this, the more solutions there will be, the more education for your providers, the more education for your family members. So we want you to come away with this, with real education and with the ability to make your own personalized plan that includes lifestyle and maybe hormones and most importantly, mindset.
14:53
Dr. Ade
Absolutely. And so we'll continue this every week. We're giving you the evidence. We're giving you empowerment and a path forward to optimizing your health in midlife and beyond.
15:04
Dr. Jillian
Thank you for joining us on the Modern Midlife Collective. I'm sure you know somebody who needs to hear the information that we shared with you today. So share this episode with a friend. Give this to someone that you think needs to hear what we are telling you. And if you have some questions for us or a topic that you think that we should cover, we do want to hear from you because you are a part of this collective. You're a part of the Modern Midlife Collective.
15:33
Dr. Ade
Until next time, stay tuned. Bye bye. Thank you for tuning in to the Modern Midlife Collective podcast. We hope today's episode has inspired you to take bold steps towards thriving in midlife.
15:46
Dr. Jillian
If you loved what you heard, please leave us a review and share this episode with a friend who's ready to step into their power.
15:54
Dr. Ade
We'll be back next week with more insights, strategies and real talk to help you live your best life at any age.
16:01
Dr. Jillian
Until then, remember, thriving at 40 and beyond isn't just possible. It's your birthright. We'll see you next time.