Dr. Jessica Shepherd
speaker
254 appearances
1 recordings
1 series
first heard May 2025
last heard May 2025
Dr. Jessica Shepherd’s voice in public audio — every appearance, attributed to the second.
Trend
recordings per month · last 12 monthsNo recordings in the last 12 months.Older appearances are listed below; set an alert to hear about the next one.
Appearances
Now, we know that it helps with the symptoms of menopause, hot flashes, night sets, etc. But when we look at bone health, it is actually proven that estrogen impacts bone health in a good way, obviously. But it's not our first line of therapy. They haven't said it's a first line of therapy.
If someone comes in and they're like, I have osteopenia, which is like weakening of the bone, that I should say, you should automatically go on estrogen. But we know it helps. So that is there for osteoporosis. Now, dementia, brain health, which to me is like fundamentally one of the biggest parts.
I would actually echo exactly what you're saying, because even in the clinical space, we need to do a better job at saying, we know this, this is data, and we should be encouraging our patients to consider, because the goal is not to say that everyone has to be on it, like it's mandated, but to give you
the data, the literature, so that you know the reason why, and you get to make that decision for yourself. But if I'm not giving you that information or that choice, you may not even know to make that decision for yourself.
Now, that was one of the studies when they looked at the WHI, which is 20 years ago. And now we have so much better research that links estrogen depletion and decline and what that does for later on in life when we look at dementia. So I'll give you numbers that make sense. When we look at Alzheimer's and neurodegenerative diseases, 70% of those cases are women.
So clearly there's a link between why are women getting this more than males? And the answer is because when we look at that sharp estrogen decline, estrogen is one of the best anti-inflammatory substances in our body.
So when we lose estrogen, we have an increase in inflammation and that inflammation causes our neurons to have hardened plaques, which lead later down the line because the course of how it builds and how it shows up is as much as 30 years. So that's why you start to see women having dementia in their 70s and 80s, but the process started back in their 50s. Why? Because of estrogen decline. Wow.
Yeah.
This is one of the biggest questions now that we see in hormone replacement therapy and perimenopause. What we used to do, and this is again when I was training, which was about 15, 18 years ago, is that we would wait till women reached menopause. It's like they almost had to prove it. They would come in in buckets of sweat and I would be like, well, when was your last period?
And they're like, well, it was five months ago. And I'm like, so sorry, can't offer you HRT. We have now gotten into a day and age where we know if your hormones are declining and fluctuating and you're having a symptom, I absolutely should be offering you hormone replacement therapy as something. Why wouldn't we? It's the car analogy again.
Why am I going to wait until there's no more car or no more gas in the engine, but I'm still plugging away? Why wouldn't when the indicator comes on, why would I not say, this is a great opportunity for me to get gas? the same thing with hormones. Why are we depleting ourselves?
Why are we allowing women to feel their absolute worst before we will offer them something that is going to help how they feel and their vitality? So what about women who are not candidates for it? What are their options? So their options, so there are actually a lot of options. I would, well, maybe not a lot, but there are options.
And so coming from a day and age when there were no options, I think that it's really amazing that we are able to offer that. I think that the list of who cannot take hormone replacement therapy is probably good to go over so that everyone can make sure that if I am or not, I need to know. Great. So this would be someone who has a personal history. right?
They themselves have had breast cancer and specifically a hormone receptor positive type of cancer, right? It responds to hormones. So the reason why I kind of doubled down on personal history is that there is a lot around breast cancer when we think I've had a family member, a cousin, an aunt, that doesn't put you in the same category as having a personal history of breast cancer.
It's a very nuanced conversation. Okay. And you definitely should be talking to your doctor specifically about what type of cancer that you've had, the course of cancer that has taken on your life, but also the age of when you were diagnosed and what that means. Okay. And the second thing is if you've had an Pulmonary embolism, you've had a clot in your lung.
Or even if you've had maybe a very large event of a clot somewhere else in your body, it has to be pretty significant for you not to be a candidate for hormone replacement therapy. And why do those two things... make you not a candidate for hormone replacement therapy?
That's a great question because of the hormones and the response of the body, whether it's the clot or the breast cancer, that introducing hormones again may precipitate or cause another event like that.
Yeah, because there's a history of has your family had it and been exposed to and what was that and why? Do you have a genetic predisposition to that same cancer in your family? So those, again, that should be where that list is being kind of narrowed down when you talk to your doctor. But I want women to, even if they have a family history, that's where the conversation starts.
I've had so many women who are like, oh, I can't do it. Then they just never talk about it. And I'm like, but what if, what if you found yourself that you can be exposed to it? Wouldn't that be great? Is there an age where it's too late to start hormone replacement therapy?
This is another beautiful question because for a long time from that WHI study 20 years ago, we used to say you can't start hormones now. if you've started 10 years after your last period, which is clinically menopause, or after the age of 60. And so we have shifted those, quite frankly, and again, it's a nuanced conversation, but there are plenty of women
Showing 141–160 of 254 · page 8 of 13
← Previous
Next →