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JoAnn Manson is a world-renowned endocrinologist, epidemiologist, as well as Principal Detective for the Women's Wellness Initiative (WHI). In this episode, she dives deep right into the WHI to clarify the research layout, key outcome, confounding aspects, as well as nuanced benefits and also dangers of hormone replacement therapy (HRT). JoAnn assesses just how a misconception of the results, combined with sensationalized headings concerning a raised threat of bust cancer, brought about a significant change in the assumption and also use of HRT. From there, they take a closer look at the breast cancer cells information to separate reality from fiction. In addition, JoAnn gives her take on exactly how one must consider the threats and benefits of HRT as well as wraps up with a discussion on just how doctors can move towards far better HRT methods.
We talk about:
Introductory [0:00] The Women's Health and wellness Campaign: the original objective of the research, hormonal agent solutions utilized, and possible confounders [4:15];
Research study style of the Women's Health and wellness Campaign, main result, and also a lot more [16:00];
JoAnn's individual hypothesis concerning the ability of hormone substitute treatment to minimize heart disease threat before the WHI [26:45];
The partnership between estrogen and bust cancer [30:45];
Why the WHI study was quit early, and also the significant modification in the assumption and use of HRT as a result of the supposed increase in bust cancer threat [37:30];
What Peter locates most uncomfortable concerning the mainstream view of HRT as well as a more nuanced take a look at the benefits and also risks of HRT [45:15];
HRT and bone wellness [56:00];
The value of timing when it pertains to HRT, the most effective use cases, and also advice on discovering a clinician [59:30];
A conversation on the prospective impact of HRT on death as well as a thought experiment on a long-duration use HRT [1:03:15];
Moving toward better HRT techniques, and also the requirement for even more researches [1:10:00]; and also
Much more.
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Concerning:
The Peter Attia Drive is a deep-dive podcast focusing on making the most of long life, and also all that enters into that from physical to cognitive to psychological health. With over 60 million episodes downloaded and install, it features subjects including exercise, dietary biochemistry, cardiovascular disease, Alzheimer's condition, cancer, mental health and wellness, and also far more.
Peter Attia is the owner of Early Medical, a clinical technique that uses the concepts of Medicine 3.0 to people with the objective of extending their life expectancy and also simultaneously boosting their healthspan.
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I’m 32 years old and started reading part I of your book some hours ago and right off the bat, thank you for putting it out there. Against my doctor’s wishes, I had a basic check of my vitals because I felt something was wrong with my chest. Blood work came back saying I’m pre-diabetic. Can’t wait to learn more about this in your book and how to structure my diet and exercise to fight this.
I have been forwarding your last conversation to my friends, nurse co workers and family members at my work assignments who express interest. Thank you for those discussions and providing this information. I decided to get hrt and am very happy with my decision. I see a lot of older women patients with bone fractures and dementia. I often wonder if they had more complete information if they might have made different choices and perhaps maintained better bone, heart and brain health.
I started menopause at 52. I am 59 now and just talked to my doctor last week about my hormones for sleep and bone health . This podcast was very interesting and I would love to learn more. Thanks for the timing of such an important topic.
I’m a doctor and although I’m not in the same specialty, I’m very interested in the topics you discuss. The topic of HRT is extremely important in my opinion for women’s health. I would like to kindly ask you to consider hosting a future podcast with an expert in the field and delve into the science and the benefits and risks of HRT as made evident by the latest research. I find your podcasts of great educational value not only to the general health conscious public but also to clinicians concerned with the well-being, longevity and reduction of all-cause mortality of their patients. I really value and appreciate your educational and research work, thank you very much and I look forward to listening to the podcast on this topic in the future.
60 this year .. started HRT last fall.. Tremendous benefits including being able to orgasm again after not being able to at all for several years due to an antidepressant. The affects overall have been so good I’m now weening off the antidepressant! It’s good to feel alive again!!
Excellent podcast, thank you Peter and JoAnn! Highly recommended listening for every woman 50+.
I’m almost 50, and I’m on HRT for about 8 months. I am a very cautious”natural organic” person , and after taking natural suplements to ease my ” pain,” I knew that I would take HRT, just for my own and my close ones sake. I’m lucky that my doctor specializes in this field, and after some tests for blood clothing and stroke, I was on it and can not be happier. I think I did escaped that “Karen” stigma just on time. You do you, but when a nice person becomes a monster and you don’t know why, then maybe you should consider that possibility.
Big thanks to Dr. P. Attia for his content, especially on peri/menopause issue, and for the book as well.
Thankfully the functional medicine drs I’ve seen have emphasized that B-HRT benefits go beyond just relieving menopausal symptoms.
This episode illustrates the power of persuasion and being a good orator. I have listened and re-listened to this podcast and if I were to exclude Dr. Attia’s commentary, I would believe that HRT is still dangerous and the only benefit is to reduce lost sleep and hot flashes due to menopause?!? Perhaps it’s her monotonous tone or fear of implicating herself by stressing the positives, though honestly this detracted from me looking into HRT unless absolutely necessary. I think you need a guest that stresses the positives backed by clinical data. If the intention was to get people to re-examine the controversial women’s health initiative and not fear HRT, it missed the mark. Please have a guest on that can speak honestly to the positives backed by clinical data to support HRT. Her responses were like a politician answering questions…though in the end left the female listener still weary.
Are you also taking/using testoterone? If so..what is form?
Dear Dr Attia,
I would like to propose a (perhaps) new angle in approaching the topic of HRT in peri- and post-menopause. I would love it if you had a guest who can take us into estradiol’s role in ALL the organ systems of a woman’s body where this hormone has functions, and preferably into a level that goes beyond “estradiol is good for the bones, heart and brain”. I have heard that there are estrogen receptors in every organ system of a woman’s body, meaning estradiol serves many purposes beyond the reproductive functions …
I would really like a more detailed lecture on what estrogen does on a cellular level to keep a woman’s body functioning optimally. I would like to learn, what happens to those bodily functions when estrogen is no longer produced by a woman’s ovaries.
Once we understand all the important roles of estradiol (and progesterone, and testosterone) in the female body, we can ask why we are not viewing and treating it as a hormone deficiency like any other (thyroid hormone, insulin, vitamin D)? Dr Louise Newson in the UK, for instance, works tirelessly in this area, to have us understand menopause as a “long term female hormone deficiency with health risks”.
Ideally, it should be a woman’s choice whether to take hormone therapy for her quality of life and to help prevent important diseases.
I love these mega experienced drs speaking about their work. You should interview Professor Susan Davis on her work on testosterone for women.
@Cynthia Hansen
I have pellets in my hip of estrogen and testosterone. Oral progesterone..100mg…. Originally doc prescribed me 200 but I’ve never smoked or drank or done drugs so I’m an extreme lightweight in that department. It was knocking me out… I’ve since tweaked it to the 100 mg and I take it about 6 p.m. so I’m nice and drowsy come 9 -930 which is great for me. This way it’s completely worn off by morning and I have my energy back. If I forget to take it early I just don’t take it at all because it does keep me kind of sluggish in the morning if I take it late. But again I’m a real lightweight!!
I had pretty good sleep hygiene before I started on the progesterone but this it’s been the icing on the cake! I sleep with the house on 62 and the ceiling fan going. I sleep like a baby now… Even on the nights I miss taking it.
I also don’t eat after 5 in the evening which helps with my sleep. I also consume zero sugar and keep my carbs very low. I have zero aches and pains between the diet and the HRT…. 20lbs fell off of me.
I haven’t felt this good in a couple of decades, mentally emotionally and physically.
If you have any questions about the sexual health benefits of it just ask I’m an open book.
Not sure where you’re at but I’m in the Waco TX area if you need a recommendation fo r a doctor. I love him and his staff!!
Ditto, I also would love to see a podcast with someone who doesn’t have a horse in the race. It seemed the focus was on breast cancer, would like more info on heart health, stroke, cognitive issues.
@The Flamboyant Grandma thx so so much! I am in utah…and a widow..so not too worried about that aspect..but more concerned about brain health an memory. I have done all those food things. Take quality supplements an nootropics. Now started experimenting with herbs for memory etc. (Personal lost 21 daughter last summer so hard to place exact cause of no motivation) want to up my testosterone for brain an drive?
@Cynthia Hansen so sorry to hear that but so glad to hear you seem to be on top of it!! Keep up the exploration and the motivation will come!
Thank you for this comment! These were my thoughts exactly.
Agreed !
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This whole thing makes me so angry, especially when the docs focus on hot flashes and night sweats. Yes, those are no fun, but my symptoms were much, much worse. I felt like I was falling apart mentally, physically and emotionally. I had almost all of the symptoms mentioned in the godsend of a book, Estrogen Matters. I would’ve given up 10 years of my life to feel better and be functional. I would’ve had a prophylactic mastectomy if that’s what it took. No doctor would prescribe estrogen for me because I had a stage 1 breast cancer in 2015. I’ve been cancer free since then and I understand the supposed increased risk in a recurrence (which I don’t necessarily buy.) In any case, it should be my choice – it’s my body and my life. I was lucky to find a friend who was willing to prescribe estradiol patches for me. My quality of life increased 10-fold in about a week. They can pry my estradiol patches out of my cold dead hands. I intend to stay on estrogen for the rest of my life. I believe that starting early will help prevent the conditions that are more prevalent in older age. I agree that it is sad that millions of women suffered unnecessarily since 2002. What about the millions of breast cancer survivors that are currently suffering? Dr Avrum Bluming has an article that goes over every study regarding estrogen after breast cancer and I am convinced that the current “contraindication” will someday be shown to be wrong. Even if there is an increased risk of recurrence, I am willingly taking that risk. Who wants to feel like hell for 25-35+ years of their life? Not me.
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Well said. While we’re at it, let’s understand exactly what natural levels of progesterone and testosterone do at a celular level throughout a woman’s body…if science has even explored this question.
I thought the same thing. I thought it was ridiculous when she said a particular result “almost reached statistical significance.” So it wasn’t statistically significant. Sheesh!
Exactly!
Dr Barbara Taylor on YouTube is a great resource for information
I had a full hysterectomy at 42, went on HRT immediately & now at 61 I’m still fit, strong & super healthy… love my HRT 👍👍
Thank you! This podcast was wonderful. Yes, I am one from that generation of women fearing hormone replacement causing cancer. Now I’m on BHRT. Thanks again
I had a hysterectomy/oophorectomy at age 23 and was profoundly symptomatic afterwards. I was initially prescribed Premarin, but after learning about liver cancer risks, transitioned to transdermal. I’ve been on ERT for 50 years, and at the age of 70 , had a hard fall from a road bike directly onto my hip, hitting so hard my hip turned black — but no bone damage… I have great bone density. Symptoms controlled by a little patch include migraine, PVCs, insomnia, soaking sweats, labile moods, formication, and insatiable appetite. Symptoms improved but not fully relieved are dry eyes and mouth, memory issues, and anxiety. I’ll be on ERT till I die, even if that comes earlier than it might otherwise.
I’m with you — hysterectomy at 23, still on ERT at 72, riding a bike thousands of miles/year, hiking, strong, lean, and healthy!
100% I couldn’t agree with you more! I am 51 (almost 52) and I got lucky to work with a Reproductive Endocrinologist who keeps up on the most current information regarding cancer risk with HRT. I use Bioidentical Hormone Replacement Therapy.
I was afraid of HRT because of breast cancer risk and have changed my mind after listening to another one of your episodes and getting to know I wouldn’t need progesterone, since I don’t have an uterus. It has changed my life. I had been suffering from menopause symptoms for years. My sleep was ruined, my insulin sensitivity was ruined. Thank you for informing us!🌻
Started HRT at 58. DEXA scan prior to HRT showed osteoporosis and osteopenia. After a year on HRT osteoporosis now osteopenia and areas of osteopenia now normal bone. This along with other benefits of HRT have been amazing.
Quite right, have you ever wondered why Doctors seem loathe to have ALL your hormones tested? They likely know that correcting them will cure a multitude of your issues with them being unable to prescribe profitable but harmful drugs.
@Marina Solt We already know this. The natural levels in your early twenties are your optimum levels, it does not take rocket science to determine an average using a large enough number of people and so calculate a beginning dosage for you to return you to those levels.
Agree 💯 I had all symptoms thought I was lost I found it have to work second job to receive it but still worth it
I love Dr Newson so much. She’s an incredible human.
You never took progesterone?
@V F did you ever take progesterone ?
I tried it twice, but it caused brain fog and some bloating, which is opposite of what many women report — so I stopped it. I obviously don’t have to take it, as my uterus was removed.
@V F What kind of HRT? I had a hysterectomy about 8 years ago at 55. I first went on an estradiol gel, but switched to the oral because the gel was so expensive and my insurance paid very little of the cost. the oral is so inexpensive that even without insurance it is affordable, I need to look into the bio identical type. I don’t even know what makes the biodentical different or how expensive it may be. I too intend to be on HRT until I die from what ever cause. Quality of life is more important to me than the length of my life. With this said, my bone scan a few moths ago did show that I had osteopenia, so hoping i can turn that around with supplements and weight bearing exercise, I.E. walking and some light weight lifting (due to my muscles seeming to going away).
THANK YOU DR. ATTIA for posting this important topic. HRT saved my life. I started getting panic attacks and memory loss and depression. HRT resolved all of my issues!!!
Would love to know who you see! Im in Austin area.
amen sister. Slightly increased health risk, somehow that is more important than the fact that I was 100% miserable and barely able to function. Everything has risk. Viagara has risk but men are allowed to weigh their own risks and make their own choices when it comes to that. we women are supposed to suck it up,”it’s normal honey” when it comes to feeling like hell in menopause. I finally got my estrogen patch and within 2 days I was back to normal. alcohol and processed foods and cured meats are far more dangerous than the damn estrogen, but no doc every tells you that. Whatever X% health risk I get from HRT, I got back several times over by eating a whole food plant based diet.
For those who were denied estrogen for hot flashes did you try the other meds like the SSRIs, Clonidine etc? I found that my hot flashes are made worse by electrolyte imbalance/dehydration.
I totally agree! The right levels of estradiol and progesterone are protective against several long-term health issues, especially osteoporosis.
Even though doctors routinely says progesterone is unnecessary without a uterus . . . it’s a major factor in menopause insomnia.
I am 45 and starting to feel like hell…feel sore, achey, night sweats, low mood…I’m young but it’s starting already.
This was so confusing.
Chiming in from Canada 🇨🇦 Can’t thank you enough for providing this unbelievably critical information. Just started HRT. Estrogen & progesterone. I’m already feeling a million times better! And finally sleeping. Thank you so very much 🙏🏻
I agree with the mental clarity comment! I had a total hysterectomy including ovary removal and HRT has given me such clarity of mind. My life is 100% better because of mental clarity. I’m 46.
That is so encouraging! Did you do anything else like take calcium or weight bearing exercise? I’ve heard those measures don’t do much if you have no estrogen. I would love to have those results. I had a similar improvement when I was on it but then I had to get off after breast cancer. I’ve just restarted!