Menopause is inevitable, suffering through it is not. In this game-changing episode, world-renowned OB/GYN Dr. Sharon Malone breaks down the myths, fears, and facts surrounding hormone therapy (HRT) and how misinformation has left millions of women needlessly struggling with their health. From the studies that gave estrogen a bad name to the life-changing benefits of HRT for heart, brain, and bone health—Dr. Malone gives you the science-backed truth every woman needs to hear to take control of their health. What you’ll learn: -Why perimenopause is the most misunderstood stage of menopause (and how to know if you're in it!) -Can you really still get pregnant during perimenopause? Dr. Sharon Malone shares her personal story and sets the record straight. -How one study changed women's relationship with estrogen for decades and why it still matters today. -Does hormone therapy cause breast cancer? What today's science truly reveals about hormone therapy and the risk to your health. -Why cardiovascular disease (not breast cancer) is the number one health threat for women, and how estrogen plays a surprising role. -The similarities and differences between hormone therapy and birth control. -Who's actually eligible for hormone therapy (more women qualify than you think!). -Why African American and Hispanic women have a different menopause experience and what it means for treatment. -How younger women can proactively prepare for menopause starting now If you’ve ever felt lost or conflicted about hormone therapy, this episode is for you. Dr. Malone delivers unfiltered, straight-talking advice to help you make the best decision for your body, your health and your future. - Get my new book, How To Menopause, Take Charge of Your Health, Reclaim Your Life and Feel Even Better Than Before 💖 http://www.howtomenopause.com → If you love the podcast and want to support it, please subscribe and rate us 5 stars! Your support helps amplify women's stories and keeps these important conversations going. - Join Tamsen's newsletter and be part of an incredible community of women navigating life together. Get expert insights, real conversations, and the latest updates straight to your inbox. Sign up here: https://www.tamsenfadal.com/subscribe Follow The Tamsen Show on Instagram: https://www.instagram.com/thetamsenshow/ Watch the Full Episode Here: https://www.youtube.com/@TamsenFadalTV Follow Tamsen Fadal: Website: https://www.tamsenfadal.com Instagram: https://www.instagram.com/tamsenfadal Tik Tok: https://www.tiktok.com/@tamsenfadal About The Guest: Dr. Sharon Malone is is board-certified by the American College of Obstetricians and Gynecologists and certified by the North American Menopause Society as a Certified National Menopause Practitioner. She is the Chief Medical Advisor at Alloy Women’s Health, a telehealth company that focuses on women over 40. Before joining Alloy, Dr. Malone was a partner at one of the oldest and most successful OB/GYN medical practices in Washington, D.C. Medical Disclaimer: The information provided in this podcast is for educational and informational purposes only and is not intended as medical advice. Always consult with a qualified healthcare professional regarding any medical concerns or treatment options. The views expressed by guests are their own and do not necessarily reflect those of The Tamsen Show. Learn more about your ad choices. Visit podcastchoices.com/adchoices
Chapter 1: What is menopause and why is it misunderstood?
Wenn du in eine nursinghafte Bevölkerung gehst, sind die meisten von ihnen Frauen. Und von diesen Frauen ist eine der freundlichsten Gründe für Krankenhäuser Urinärinfektionen. Und wir wissen, was passiert. Urinär-Trakt-Infektionen können zu Sepsis führen. Die Veränderung des mentalen Status in den Älteren. Also es ist nicht nur ein, oh, schön zu haben.
Das ist wirklich ein Gesundheitsproblem, das wir beantworten müssen. Und ob oder nicht Sie systemische Hormone auswählen, von denen wir geredet haben, kann jede Frau vaginale Estrogen benutzen. Sie behält die Integrität der Vagina, schlägt auf Urinär-Traktinfektionen und all diese anderen unbedeutenden Dinge, die mit dem Alter passieren.
Ich möchte HRT und Hormontherapie und Menopausen-Hormontherapie unterbrechen. Es geht um viele Dinge, es gibt viel Verwirrung. Es gibt viele Informationen, man kann auf Instagram gehen. Jeder hört jetzt das Wort Perimenopause und Menopause. Was ist also Hormontherapie?
So, I want to make it clear, because I still use the old term. I say hormone replacement therapy. I don't think replacement is a bad word, but obviously someone objected to it. Sharon tells it like it is, and that's what I love about it. I'm like, what's wrong with that? I don't have a problem. But hormone replacement therapy, menopausal hormone therapy, same, same.
Und all it means is that when you reach either perimenopause or menopause, then you are using hormones to treat hormonal problems. And, you know, because we know in menopause, it is really defined by a persistently low lack of estrogen and lack of ovulation in the fertility forever or not.
So you are just giving back, not at the same levels that you had when you were ovulating and you were premenstrual, but you are giving back just enough to take care of the symptoms, all those gnarly symptoms that come up with menopause. Hot flashes, mood swings, night sweats, sleeplessness, brain fog, the list goes on and on and you know it.
So you are giving back a smaller dose of estrogen and progestin for women who have a uterus. And if you've had a hysterectomy, then you can be treated with estrogen only. Because estrogen is really the secret in the secret sauce that controls the symptoms that women have during menopause. So that simply is all menopausal hormone therapy is.
But to give you an idea, women are so afraid of menopausal hormone therapy. Women are afraid of menopausal hormone therapy who've been on birth control pills for 20 years. And I just look at them and I'm like, girl, you've been on estrogen and progestin since you were 25. And you're going to be taking far less of it. in Menopause than you did before.
And somehow, you know, again, it's a perception problem. Of course it is. It's a branding problem. Menopausal hormone therapy is anywhere from a third to a quarter of the dose of what's in a standard birth control pill. It is? Yes.
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Chapter 2: Can you still get pregnant during perimenopause?
And believe it or not, the first spokesmodel for estrogen was Lauren Hutton, the beautiful Lauren Hutton. And she was out there. And, you know, so now, again, we're getting back to that same sort of, you know, Ja, wenn du Estrogen benutzt hättest, hättest du Lauren Hutton aussehen können.
Die Vanität davon. Ja.
Versus die Gesundheitsbedürfnisse davon. Und wir auf der Doktorfront versuchen wirklich die Gesundheitsbedürfnisse zu beurteilen. Und so gab es viel. Also, du weißt, das Pendulum schwingt wieder und jetzt ist es in Bezug auf Estrogen. Ja. Dr. Bernadine Healy, may her soul rest in peace, was the first female director of NIH. And she was a cardiologist and a woman of a certain age.
So she was very much interested in doing a study Das betrifft Frauen, postmenopausalische Frauen. Und vor ihr, hatte es noch nie eine large-scale Studie betroffen, die Frauen betrifft, postmenopausalische Frauen. Nun, das ist schwer zu glauben, aber das Studium wurde in 1991, 1992 begonnen.
So in the 90s, that's when we've said over and over again, that's the first time that women were mandated to be in studies, correct?
And it was her urging that really got the focus, you know, on women in midlife. And so she started the study. Unfortunately, she was not there as the study progressed. But, you know, we said, oh, great, now we're going to prove that.
Once and for all, this little observational data that we have about cardiovascular disease, we're going to prove it, because we are going to do a gold standard, randomized, double-blind, placebo-controlled study, and we're going to manipulate it such that we're going to prove once and for all that it does decrease the risk of cardiovascular disease. That was the point of the study.
Nicht, ob es Hot Flashes beherrscht, nicht, ob die Frauen ihre Leben durch Hormone verbessert haben. Das war nie der Punkt, denn das wurde damals erstellt.
Das Studium wurde also für die Leute, die gerade über dieses 2002-Studium gesprochen haben, umgesetzt. Wir kennen dieses Jahr, richtig? Wieder und wieder. Das wurde umgesetzt, um zu sagen, hey, Es gibt einige langfristige Vorteile davon, wenn es um kardiovaskuläre Gesundheit geht.
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Chapter 3: How did a single study change the perception of hormone therapy?
And that if you took these awful hormones, you were going to get breast cancer. And women abandoned hormone therapy in droves. From a large percent, right? From about 38% of women who were eligible to take HRT. It went from about 38% to less than 6% and it has persisted. It is still in about the 5% range even today. 22 Jahre nachdem das Studium herausgekommen ist.
Und du weißt, das ist nie das Ende der Geschichte, weil, du weißt, es ist schwer für Menschen zu verstehen, aber es gab ein Zeitpunkt vor dem Internet und bevor wir instantan Zugang zu Informationen hatten. Und als sie diese Pressekonferenz gehalten haben,
Even the investigators who were participating in 40 centers around the country had no say in the stoppage of that study, in the article that came out that made these claims about increased risk of breast cancer. It's sort of a small group of regulators at NIH came up with this.
They put it out and immediately, it wasn't like it was years later, the doctors who were involved in the clinical trials protested. Weil sie dachten, warte, warte, warte, das ist nicht wirklich das, was es gesagt hat. Aber wiederum, 22 Jahre später versuchen wir immer noch, das Genie zurück in den Bottle zu legen. Und es war schwierig.
Sie haben die Idee zementiert, dass Estrogen Breastcancer verursacht. Was haben sie in diesem Studium gefunden?
Wir haben ein paar Dinge von der Women's Health Initiative gelernt. Es war ein großes Studium. Aber hier ist, was der grundlegende Fehler war, oder die grundlegende Missinterpretation der Daten.
Wenn du ein Studium konstruierst und sagst, wir versuchen, zu beweisen, dass es den Risiko für kardiovaskuläre Krankheiten reduziert, und wir werden es mit heiligen Frauen tun, und wir werden dich über Jahre folgen, um herauszufinden.
Nun, der Grund, einer der Gründe, warum sie in dem Studium jüngere Frauen nicht wählten, war, weil Frauen nicht, wir sehen nicht den Aufprall in kardiovaskulären Krankheiten bis etwa zehn Jahre nach der Menopause. So they can't start a study and say, all right, we're going to start at 50 and I'll come back and check you out when you're 70.
So they skewed it such that the women were much older at the start of the study. So the average age of the woman entering the Women's Health Initiative was 63. And you could be anywhere from 50 to 79 and still be in the study. Well, that may have sounded, you know, I understand their reasoning. However, that was not typical of who we normally prescribed hormones for.
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Chapter 4: Does hormone therapy increase the risk of breast cancer?
Wenn du jüngere Frauen Tipps geben würdest, wie sollten sie sich für Menopause vorbereiten, gerade jetzt?
I say things over and over and again because I think that hopefully they'll sink in. Achtet auf euch selbst, exerciziert euch, achtet auf euer Gewicht, macht sicher, dass ihr eine Diät habt, die nicht voller von, weißt du, unterverpackten Füßen ist. Aber nochmals, es gibt ein bisschen Freude, nicht alles. Aber versucht, besser zu sein.
Und wenn du diese Dinge tust, weil ich denke, es ist so wichtig, weil je besser in Form du bist, in diesen Prozess zu kommen, desto besser wirst du am anderen Ende davon herauskommen. Und das andere, was ich dir sagen würde, ist, stopp dich von Gewicht zu besorgen. I want you to pay attention to what is healthy for you.
And you go to your doctor and your doctor will tell you, is my blood pressure good? Is my blood sugar good? Am I not showing any signs of metabolic syndrome? Then that's good. And we've got to leave that sort of impossible image behind.
Focus on health, not on weight. I want to talk about age and I want to go back to one thing that we've talked about before and we addressed in the documentary, but I'd like to address it here. Wir sprechen von afrikanischen Frauen, die länger perimenopause haben, aber auch, ich weiß, wir haben darüber gesprochen, dass es nicht genug Forschung gibt, aber auch intensivere Symptome.
Können wir das beantworten?
Ja. Es gibt eine Studie, die sogenannte Studie der Frauen auf der ganzen Nation, oder die SWAN-Studie. in denen sie schon seit über 25 Jahren eine Gruppe von Frauen folgten, vor der Prämenopause, durch die Perimenopause und so weiter. Und da haben wir viele Informationen dazu, wie lange es dauert, um durch diese Transition zu kommen.
Und es hat eine sehr repräsentative, eine sehr diverse Gruppe von Frauen, die sie folgten. Und das ist das, was wir gefunden haben, dass die Erfahrung der Menopause anders ist, abhängig von verschiedenen ethnischen Gruppen. African American Women tend to go through menopause earlier, about a year earlier. Hispanics a little bit earlier, but not as much as African American Women.
Their symptoms start earlier, they're more severe, they last longer, they complain about them the least, and they're the least likely to get a prescription for medication, even when they complain about them. So the experience and is it something so different about being, you know, is there something biologically different between African American women and white women in this country?
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