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Mache Seibel, MD is a leading authority on women’s wellness and hormone health and a member of the Harvard Medical School faculty who has treated thousands of patients. His expertise includes infertility, perimenopause, and menopause. He’s provided coaching advice to some of America’s top women executives and entrepreneurs and to women around the world. He’s on a mission to help women enjoy the life they want by helping them figure it out, so they don’t have to tough it out!
Dr. Mache is a co-author of A Woman’s Book of Yoga, and author of the best selling books, The Estrogen Window and The Estrogen Fix as well as 12 other books and over 200 scientific articles. He is Editor of The Hot Years Magazine.
Dr. Mache speaks internationally and his media appearances include PBS, NPR, MSNBC, Fox, ABC, NBC and CBS. He’s also been featured in People Magazine and interviewed by multiple print media including the NY Times, Wall Street Journal, Washington Post and many others.Dr. Mache lives in Boston, Massachusetts with his wife Dr. Sharon Seibel; they have three adult children. Find him at www.drmache.com.
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Reena Jadhav: Hi everyone. It’s Reena Jadhav here, founder top bootcamps hosts of the healthier podcast coming to you today, both via video as well as a podcast. So if you are listening to this on iTunes or on SoundCloud case note, there’s a video to go with it. Just check us out on health bootcamps.com or of course our youtube channel health through camps, and you can check out the video. All right, let’s get started. To some of you who follow my journey, know that I’ve suffered from all kinds of hormonal issues including menopause a couple of years ago, which of course room into the throes of hot flashes and night sweats and hair loss and wrinkles and insomnia and mood swings. And of course, it’s a very, very long list. And so I’ve always been very, very interested in understanding what can we do naturally to treat ourselves because women suffer significantly in this nation. And the cost is cute. So today I had the most amazing genius amongst us, Dr. Seibel, Dr. Mache, welcome
Dr. Mache: Reena. So nice to join you.
Reena Jadhav: So let me give you all a little background on how amazing Dr [inaudible] is. He is an international health expert and leading authority on women’s wellness and menopause. In fact, for over 20 years he’s been on the Harvard Medical School Faculty. He has written over 15 books, 200 scientific articles, and has received so many awards, including the Gates Foundation Grand Challenges Exploration, the media award. He’s also the founder of the hot years, my menopause magazine. He’s been a host for PBS and various other television shows. He’s been repeatedly voted one of the best doctors in America. So with that said, I welcome you Dr. I’m really excited to talk today about your book, the estrogen fix. So what great books of the estrogen fix the breakthrough guide to being healthy, energized, and hormonally balanced. Let’s get started with the first question, which is why did you write this book?
Dr. Mache: I’m glad you asked me that question, Reena because this book was to be a very personal experience because, in the beginning of my medical career, I was actually a top expert in infertility. I did some of the first in vitro fertilization in the United States, but what happened was around 2002, there was a study called the women’s health initiative, which I’m going to talk about with you in a few to be very afraid of hormones because of some misunderstandings in reporting on that study and what happened was only seven months after that study came out, my wife had surgery that threw her into early menopause and because it was so close to the women’s health initiative, none of her doctors were really comfortable treating her are keeping her on hormone therapy. So as I say, I had to figure it out so she wouldn’t have to tough it out. Chapter one, which is estrogen behind the headlines.
Dr. Mache: What is the essence of this chapter? What do we need to know about estrogen that the headlines are not covering today? The main thing that is important for women to understand is one of the most senior, utterly important studies on Women’s health and particularly for menopausal women was this so-called Women’s health initiative are the wea age and the study was well intended and unfortunately they got it all wrong and I’ll explain to you why. Just very simply, and the reason is as follows, in this study of thousands and thousands and thousands of women instead of comparing women are the same ages. The women who got hormones in this study were in their sixties and seventies and the women who got a placebo were in their fifties. And so what happened is when the study was done, they compared women in their sixties and seventies taking hormones with women who were in their fifties taking a placebo or sugar pill and they attributed the fact that the women who were taking the hormones had more problems exclusively to the fact that they were taking hormones.
Dr. Mache: They did not factor in age as a variable and not only age, but how many years they had been in menopause and what we’ll talk about, which will pop up repeatedly in different chapters, is the fact that when these same data, the same exact data where reanalyzed the women in their fifties and sixties, there were still a few of them that were in their fifties. They got the hormones and when they compare the women who were in their fifties who got hormones to the women in their fifties that didn’t. The problems went away. And as we’ll talk about, depending on which organ system, whether we’re talking about the brain of the breast or the bladder or so forth. What we’re going to talk about is you’ll see that in some instances the women who received hormones actually had fewer complications. Fewer risks than the women who took nothing.
Dr. Mache: And so this has caused as a result, over 80 percent of the women who were taking hormones to throw them away and stopped taking them. And what that has done is two things. It has caused women for a generation to do without hormone therapy. And suffer the symptoms of menopause without feeling they had a treatment option. And the second thing that it’s done is because there were so many fewer women on hormones there are today than there were in 2002, there are 80 percent fewer women today taking hormones today than in 2002. And because the doctors in training over the last almost 20 years have no patience to learn from entering to have experience treating menopause. So we have a self-perpetuating cycle in which the doctors aren’t comfortable, the patients are uncomfortable, you put two uncomfortable people together and they ended up not getting treated optimally is a big issue for women. And the impact on women’s health, on the quality of life, on the quality of their work, on the quality of their relationship has been immense. And it has been in a negative, uh, had a negative impact.
Reena Jadhav: And so you firmly believe that doing hormone therapy does not create negative consequences that outweigh the benefits of not doing hormone therapy.
Dr. Mache: Let me say that slightly differently, but the majority of women, that’s true. There are always going to be some people who are poor candidates for any medication and that includes hormone therapy. Maybe you already have breast cancer, maybe you have a certain liver condition, maybe you have a bleeding disorder, et cetera. There may be these circumstances, but overwhelmingly, if they started near the time of menopause, which I called the estrogen window, this critical window of opportunity. If they do that, then the benefits far outweigh the risk and it’s not just my opinion. This is now been proven over and over by looking at the exact same data, but analyzing it with with the consistency of age instead of these two disparate groups.
Reena Jadhav: Here’s the challenge we face today. There is so much misinformation out there that once someone has formed an opinion, and I know this because I’m surrounded with people who shared their opinions with me, including my own mom, no, it’s bad, and whatever information is coming out now is incorrect. How do we convince the women out there that are listening to us right now and they have that still, that niggling doubt? Should I be believing this? What can you share to help them get over that hump of distrust that no hormone therapy is going to kill me because that’s literally what my mom said? Well, because I want to die early. Sure, I’ll take hormone therapy, but you know, I want to live a long life. I don’t want to do hormone therapy.
Dr. Mache: Shut up. You really want to do it. Live a long life. Take the hormone therapy. Because the study came out just in the last six months, showed that when they looked at the women who had taken hormone therapy, any kind of hormone therapy, even the ones that took it later with the problems, it’s everything. The women, whoever had hormone therapy live longer than the women who never took hormone therapy. If the women took hormone therapy for 10 years or longer, if they took it for five years, it was no difference if the ticket for 10 years or longer, it was about a 40 percent. Uh, there was an increment of a, of a number of years difference. And if they took it for over 10 years, it was even a greater increment of living longer. But to answer your question, I realized that once something becomes emotional and becomes a fear, it’s no longer an intelligence issue, an emotional issue.
Dr. Mache: We just like some people don’t like the mellow strawberry chocolate. You can’t tell him that. Tell him it’s good. But what I have learned from talking about this all around the country have on my book tour and other experiences as I’ve spoken about hormone therapy all around the country. There’s always a handful of women in every audience that is in their seventies or even older. And I asked them, you know, why are you here? Because you’re sort of past the window when people think about hormone therapy, why are you here? And they will say, always, I’m here because I had such a good experience taking hormone therapy. I wouldn’t give it up when all that scare came out and my daughter won’t take it. And I want to make sure I’m not doing anything wrong by encouraging her to take it. So moms are still trying to help their daughters in their fifties, you know, they’re still trying to be the mother that cares and is getting information to give motherly advice. And the thing about it is it’s so challenging when you’re about to go into puberty. Moms have that talked about to get pregnant or have a baby. Moms have that talk, but when you’re about to go into menopause, moms don’t have that talk. There’s no connection between the older generation and they are currently going through generation to convey that motherly wisdom. And in this last generation, the cycle has been completely upended because of the poor interpretation of a study that was designed with a flaw that ruined everything in terms of accurate information.
Reena Jadhav: One more fear that comes up is cancer and hormones, right? What information can you share? What research can you share to dispel the myth that hormones cause cancer? Or maybe it’s not a myth. Can you shed a little more light on that?
Dr. Mache: So let me answer your question briefly because I’m going to be talking about it more as we move through the various chapters. But in a nutshell, people, women are worried about breast cancer. I mean, let’s face it if you talk about what’s the one thing that women worry about the most? Everyone’s got a pink ribbon and they’re marching, you know, in the different things. Well, the issue is this, for women who take in, this will come up in a few minutes when we talk about in the next chapter, how to take estrogen and so forth, but some women are taking women who have a uterus, have to take both estrogen and some type of progesterone because that protects the uterine lining. Women who don’t have a uterus who’ve had a hysterectomy don’t have to have progesterone. They only need to take estrogen, and this is a very big part of some of the other confusion, but the women who take estrogen, progesterone, the risk of breast cancer in that instance, is about the same as the risk of being overweight, about the risk of having dense breasts naturally.
Dr. Mache: So it’s about one in a thousand. That’s the risk with estrogen and progesterone. For women who don’t have a uterus and who take estrogen, only this assumes they started in the estrogen window close to the time of menopause. The risk of breast cancer is 23 percent lower than the women who take nothing. Twenty-three percent less risk of cancer of the breast. If you take estrogen-only then if you take a placebo. So it’s actually safer to take estrogen and only bay basically the same to take estrogen and progesterone, not really an increase or decrease. Alright, let’s get to chapter two. Estrogen. What’s the essence of that chapter? While the essence of that chapter as Virginia, you are really to say that, you know, when we think about women, what do we think about? I mean, I asked my mother who’s 93 and she said, well, girls are sugar and spice and everything nice.
Dr. Mache: And so I say, well that’s, that’s exactly right. And they said if I were adding to it, I would say, and a splash of estrogen because when you think about it, every major event for women involves estrogen. When you go through puberty, your estrogen is going from baseline up to in an erotic way, but it’s going up towards your reproductive levels and then with that estrogen comes, you’re curvy hips, it comes to your breast development, it changes your brain. You start thinking about boys and you start thinking about sexual things that come to mind and all these things are going on because of these hormonal changes. Now it’s not the only estrogen, but it’s primarily yesterday. When you go through your reproductive years, you’re having a menstrual cycle, so you’re having hormones. That’s every 28 days or 30 days or so are going through a cyclic change in during those times.
Dr. Mache: You’re having the lining of your uterus built up, ready to receive a fertilized day, and if you don’t get pregnant, well you have a shedding of the lining. You have a period, you start all over again, and when you go from your transition, from reproduction into perimenopause, that window of time that precedes menopause. It can be up to 10 years in length when you’re going through that timeframe. Once again, we’re talking about the same hormonal changes that were happening in puberty only they’re happening backward is Ginger Rogers said to Fred Astaire, I had to do everything you had to do only in high heels and backward, so the same hormonal things were going on a for women backward, and then when you get to menopause, now you have those hormones back down to prepubertal levels again at a very baseline, so you have this life cycle of change in hormones, so this is kind of estrogen is, is, is totally tied to women. They’re very being their essence, their thinking, their bodies, everything about them, and so it’s an integral part of a woman’s life.
Reena Jadhav: All right, let’s get to chapter three, which is the estrogen fix. Choosing the right hormone therapy for you. That’s a good one. Dr. [inaudible], how do we go about choosing the right hormone therapy?
Dr. Mache: It’s always good to work with somebody who knows what the choices are because there’s a lot of estrogens out there, but as I began speaking about in the initial comments, women decided to take estrogen and brushstrokes based on whether or not they have a uterus are they don’t, which estrogen is the right one, and so women who have a uterus, and this is very important, required both estrogen plus some form of progesterone, and what that does is it protects the uterine lining from developing precancerous changes in both. You don’t have to worry about that, so you can’t take estrogen. Only if you have a uterus, you can take estrogen, progesterone. It’s all safe. It’s all good. Then if you don’t have a uterus, you have had a hysterectomy. You only need estrogen. Then comes many other choices because estrogen comes as pills. Estrogen comes as patches.
Dr. Mache: Estrogen comes as gels. Estrogen comes in sprays. Estrogen comes as pellets under the skin and rings that go in the vagina, in creams that go on the skin and in the end, the vagina. So there are all these ways to take it. In general, if women take lower dosages, it’s always the kind of start, the lowest and if women use topical Estrogens, meaning on the skin, then it tends to lower the risk of any blood clots or side effects or complications, but every woman is individualized based on your medical past, based on her personal preferences and based on her beliefs are thoughts about what would work best for her lifestyle. Like maybe she takes a pill because every night is by the sink and she knows to take it. So some women who have been taking say birth control pills forever. It’s just normal to take a pill, a pill. Do you want a period are you don’t want to have a period because you can take hormone therapy so you never have a period or so that you have a cycling, have a period every month or however it’s determined you want to have it. So all of these things go into a discussion, go into the decision that, you shake it up and then you choose the one that works best for you.
Reena Jadhav: You know, I’m going to share my own experience at this point. So as some of you who’ve been either a familiar with my work or read some of my articles, I know that I was very sick. Then I had menopause and had to experience it all sort of at the same time. And of course one of the things that I heard over and over again was how birth control pills really negatively impacted the gut. In fact, I had one, integrative doctors say to me, I cannot hear you if you don’t stop taking the pill. And at that point, I had been put on the pill by a doctor about six, seven years ago because I was starting to have erratic periods probably because I was on in Perry menopause. I had ovarian cysts that had burst and I had all kinds of wonderful, painful drama.
Reena Jadhav: With that said, Dr. you know, I then did a ton more research to find out if that was true, that if being on the pill could impact the gut negatively. And there is some research to that effect. And so I switched out of ingesting things that would impact my gut. And of course, the liver. And um, looked at applications that were more topical in nature and specifically that were perhaps just, you know, vaginal insertion. So as an example, could you share just a little bit more around what is your, uh, research share in terms of pill versus lotions and potions and patches?
Dr. Mache: Sure. A couple of things about this. Again, some of it has to do with preference, but when we talk about what’s the medical input to it, I will give you the mirror image to what you were talking about in terms of estrogen and the gut. And that is that not only does taking the pill potentially affect the gut and don’t forget the birth control pill is a much higher dose than most of the hormones that women take in menopause. It’s a higher dose in those, there’s more synthetic and they have a totally different chemical structure in what is often taken for menopause. So, so let me begin with that. The second thing is, is that but your gut also, the bacteria in your intestines also affects what happens to those hormones. In other words, what’s really amazing is that if you have kind of an intestinal tract, bacteria that aren’t healthy, you’ve been eating a lot of fast foods, a lot of sugars, a lot of white flour, a lot of things that you may have some allergic potential to.
Dr. Mache: Maybe it’s corn, maybe it’s maybe its milk, maybe it’s whatever it is that made you allergic, that you may have a mild allergy to that changes the bacterial composition. Just like in your swimming pool when you see the algae and the gets too alkaline and things change and you have all of a sudden the pool, it’s got the green stuff in it. So what happens is when estrogen comes into the intestinal tract, it’s not metabolized the same way and so it impacts the levels of hormones that your body is exposed to. You take the same dose, but what comes through your intestinal tract, particularly if it’s oral estrogen, is going to be completely different. Those different, you know, amount of metabolizing estrogen that if you had a healthy bacterial flora, you wouldn’t have a much better digestion because the bacteria in which there are about three pounds of bacteria.
Dr. Mache: There’s, there’s about 10 times the amount of DNA and in living organisms in their intestinal tract. Then there aren’t all the cells of your body, so those cells are not, are actively digesting the foods and the pills that we take, and so the healthier your intestinal tract in the beginning, the better. Having said that, when you ingest the pill in general, it goes through your Esophagus, into your stomach, and then it goes into what’s called the intro hepatic circulation. So what happens is is that it goes into your liver and the liver then is metabolizing it and responding to the estrogen. So all of a sudden you’ve got this huge concentration of estrogen in your liver. That starts to create clotting factors that start to create high levels of cholesterol and LDL cholesterol does things that are to have some more negative impacts impact.
Dr. Mache: So as a consequence of that, that’s called the first pass because it’s going through and it’s the first time through the liver. The reason for the reason that estrogen, oral estrogen, and higher dosages have been shown to have a little bit increased risk of blood clots is because these increased clotting factors are manufactured by the liver, but if you take it through the skin or the vagina, then what happens is it bypasses the liver and you don’t get that first pass effect. You don’t get that increased blood clot. So I hope I’m not overstating it here, but the point I’m trying to make is that it’s healthier, in general, to take the lowest dose orally or can use it through the skin or vaginally.
Reena Jadhav: Perfect. Thank you so much for clarifying that because I know for a fact when you go to the gynecologist, they don’t go into this much depth, so thank you for sharing that. Alright, chapter four, the estrogen fix and your breasts. Let’s talk about that. Breast cancer is on the rise. It significantly impacts women. We’ve got some very famous personalities. Bring it even further. More to the top of the media and news conversation does this a little bit about the connection and what can we do to protect our breasts.
Dr. Mache: The most important thing, of course, estrogen effects the breast because as we talked about earlier, breast development, you go from basically looking like a voice chest to being a voluptuous woman because of estrogen, so estrogen is causing breast development. The lobules and the glands of the breasts are all developing and that’s all a result of a hormone of hormones, but if you want to take estrogen and take it safely this. The way to do that and accomplish that is we were talking about a little bit earlier, is to take it close, to start taking it close to the time of menopause. This is called the estrogen window and I caught the estrogen window and what as a result of doing that, you don’t have the break in the constant exposure of the breast to estrogen and if you take estrogen only, you lower your risk of breast cancer by taking estrogen.
Dr. Mache: If you’d take estrogen and progesterone together, which is necessary. If you have a uterus, then the risk is minimal, if any, and basically kind of a no difference. The other, uh, the other thing to think about of course is women. When women do who have had breast cancer, this is a very complicated thing and I won’t go into what’s controversial here. I want to keep it very simple. So what I want to say is there are two forms of estrogen in terms of generally there’s the estrogen that goes to your whole body and there’s the estrogen that goes into the vagina locally. Estrogen that goes into the vagina locally can be taken even if you have estrogen receptor-positive breast cancer, this is very important. One of the biggest complaints right now that I see for women with breast cancer is they are struggling with that dryness, with painful sex, and they are really in a bad place with this very important part of intimacy.
Dr. Mache: Many times women have lost their breasts. They don’t feel as pretty perhaps some of the time. They wanted to be able to feel close and intimacy as a very important part of that. And if you then take away any pleasure with sex because of lack of estrogen, that’s a real shame and this opinion piece that came out from the American College of Obstetricians and gynecologists about a year and a half ago, looked at all the studies of people who have vaginal estrogen, local estrogen, and they found that taking estrogen, if nothing else is working and you can’t use alternative products that can get moisture to the vagina if nothing else is working, taking local estrogen does not increase either the risk of death or recurrence in women with estrogen receptor-positive breast cancer. That’s very, very, very important. There’s another point I want to make about breast cancer. I see a lot of patients that have the so-called breast cancer gene, the bar sees a breast cancer gene.
Dr. Mache: These women are often going to have to have the restroom move and they’re often going to have their ovaries and tubes removed at about age 35. This is done because they want to lower their risk of breast cancer or ovarian cancer, which is overrepresented quite a bit, and women with the BRC, a gene, depending on if you have prca one or VRC two. What has been found more recently and when I talk about this in my book and what to do and how to go about it, is that if you have the BRC, a gene, and you have your ovaries removed, the data suggests that taking hormone replacement therapy does not increase your risk of breast cancer any more than it was without having the BRC. Aging. In other words, is just whatever. Whatever issue be RCA brings to the table doesn’t change because you give take estrogen.
Dr. Mache: It doesn’t increase your risk of breast cancer any more than just having the gene. So that’s very important because women really need to know that they are not going to be thrown into menopause at age 35 or 38 or whatever age it is. Usually, it’s 40 or below, and that, of course, is early menopause and it’s important to realize that about five to 10 percent of women go into menopause before 45 and about one in 100. Women go into menopause before age 40 in about one in a thousand women go into menopause before age 32. A menopause is not about age. Menopause is about the transition that can happen at any age.
Reena Jadhav: Get to the next chapter, chapter five, the estrogen fix and your heart. That was the essence of this. To what extent should we be worried about our heart?
Dr. Mache: Well, we’ve been talking a lot about breast cancer and we haven’t mentioned the heart at all. This representation of the reality because you’re 10 times more likely as a woman to die of heart disease than you are of breast cancer 10 times more, and here’s the thing that’s so important. If you are a woman who is one that I just mentioned, they go into early menopause before age 45, your risk of heart disease, and that’s up to 10 percent of women. You’re your risk of heart disease goes up immensely. It goes up immensely because you’re going to live a lot longer without estrogen and estrogen helps prevent plaque. That cholesterol, sticky cholesterol that goes in your arteries, it narrows them. It helps them from sticking to the lining of the arteries and therefore lowers your risk of heart attack because estrogen is going to keep the plaque away and so it’s really important for women in terms of heart disease.
Dr. Mache: Once again with estrogen and progesterone. The risk of heart disease is minimally improved but not tremendously improved with estrogen. Only the risk of heart disease goes down by about 32 percent. Now, this is something that’s killing 10 times more women than breast cancer. So hormone therapy is incredibly important for lowering the risk of heart disease in women. And I hope that women will read this book, the estrogen fix because you will walk away with much more information. And one of my reasons for writing it isn’t to empower you to become a partner with your healthcare provider because you need to go in because you have to be prepared because your health care provider may or may not be as prepared as what the optimal because of the very reasons I mentioned the beginning. There are 80 percent fewer women for them to have experience with.
Reena Jadhav: Exactly. All right. Chapter six, which is the estrogen fix and your brain. Now that’s a big issue. Dr [inaudible] brain fog is, is rampant in women that are going through perimenopause or menopause. I still remember walking into a room and having no clue. I had just walked in here. So tell us a little bit
Dr. Mache: these. You remember it was a problem. That’s a good start.
Reena Jadhav: Very true. I didn’t know it was a problem when I forgot in the middle of speaking to my husband. What exactly I was saying. Well, we all knew it was a problem. Thank God I got rid of it.
Dr. Mache: Yes, indeed will look there. The estrogen is very important for the brain in women. Very important. One of the things that cause the mood swings, they sort of foggy brain and the poor areas of thinking has to do with the fact that estrogen increases the speed in which the nerves of the brain communicate with each other. So you’ve got basically the brain is just an enormous series of short nerves, one connecting to the next, to the next, and then they spread out like this huge web, but it’s all wound together and it’s amazing computer, like the most amazing engineering and wiring job you’ve ever seen in your life. The way we think our move is by one of those nerves talking to the next post, the next to the next. It hits a bifurcation. It goes, one son goes that way so it goes this way.
Dr. Mache: And then they talked to the next. And so estrogen speeds up the, uh, the, the quickness that that happened. So it’s going to help your balance, going to help your mood is going to help your cognition, your thinking. Where it matters a lot is in a couple of areas in particular because usually, most problem areas are going to get better. In about three to five years is going to be a window and it can be very challenging, but they may get better without taking hormone therapy. Now, here’s a couple of examples where it’s really important to know about. Number one, if you go into early menopause, your and you don’t take hormone therapy, your risk for dementia goes up to as much as seven. Oh, 70 percent more. This is a big deal. That’s huge. It’s amazingly huge. That’s number one. Number two, if you do take estrogen, and this is a report that came out just in the last few months, if you do take estrogen, your chances of getting dementia to go down amazingly as long as you stay on it for a window of time and you started it in your estrogen window, so and if you want to prevent them into our lower, the chance of it, and I can’t tell anyone, they can prevent it, but they can lower their chances.
Dr. Mache: I would significantly. You started. If you go into early menopause at the time that you go into menopause and you stay on it at least until 51 or so, which is the age at which you go through menopause naturally, so that’s very important. The other area is that there are a lot of people. Probably 30 percent of the population has a mental health issue. It could be depression, could be bipolar, could be anxiety, could be any of a number of conditions when you have this as an underlying problem and go through menopause. If menopause isn’t treated, then your problem, your mental health problem could become less easy to control, so this becomes very important to work with your health care provider and what I see women in my practice, Israel hospital or when I do menopause coaching with women or by phone or skype. I’ve got a lot of mental health issues and helping women get through this period of time because depression, anxiety is unfortunately all too common. Some of it will pass, but if you have an underlying mental health issue, not so much.
Reena Jadhav: Next chapter, Chapter Seven, which is the estrogen fix and the bones. We are all very worried about our, uh, our hollow bones, Dr. Tell us how we can protect our bones.
Dr. Mache: Well, last year, Jim will help you keep strong bones. It will help you lower your risk of hip fracture and this was a finding from the women’s health initiative and it will help you remain a much more strong when you age. This is incredibly important because a lot of people are worrying again about breast cancer, but if you’re a healthy 50-year-old woman and you go into menopause, you’re just as likely to die from breaking your hip or a complication osteoporosis as you are dying from breast cancer, so you must protect your bones. The thing that’s important, again, this estrogen window, if you protect, if you start taking it with a certain number of years of menopause, any bones that are lost can be built back up and you reclaim that calcium in your bones. If you don’t start taking it within a window of time, you may be able to get some of your estrogens at the point of where it is. You won’t lose more, but at least you can keep it steady. So timing is everything. Prevention is incredibly important and there’s no question about the benefit of estrogen on your bones.
Reena Jadhav: Alright, let’s get to the next chapter, Chapter Eight, which is the estrogen fix and vagina bladder and your skin. What’s the connection there?
Dr. Mache: The cells of the vagina, the bladder scan, they may seem, you know like, um, they’re not so related, but they are and tied into the skin is osteoporosis because not only are you do, you have bones in your arms and your legs and your back. These little things right here, our bones, when you start losing your bones, your skin starts to sag and so your skin looking good and healthy is going is tied into the same issue of the osteoporosis. It makes your face switch from a point in sharing this and it switches it instead to an upside down triangle. It changes the shape and that’s why you get that, that change. So I’ll ask you a person’s skin to go together. A lot of it has to do cause loss of bone, but also because of loss of Collagen from under the skin and just like your bones, the skin is losing that college and the scaffolding under your skin that keeps it taught and stretched and looking younger.
Dr. Mache: It’s losing it rapidly after menopause. And that’s why there is a window of time when it comes to the, of the bladder and the vagina. And one of the common problems that women have is that sensitive bladder. It’s out. You know, without the estrogen they lived, the cells are lost. And what ends up happening is that there’s more frequency and they’re always being, you know, the women always know what the next bathroom is when you start to get women towards menopause at a 40-year-old woman, she’s going through the memorial, but she knows on the way to the mall where to stop. And when she gets to the mall, she knows which of those stores has got the bathroom right around the corner. So that’s just standard. But estrogen helps to lower that.
Reena Jadhav: And I’m going to share my experience, however, embarrassing it is. Um, so my husband had commented, you know, a couple of years before I actually hit menopause, how I was selling, go to the bathroom and a lot, and I said, yeah, you’re right. And in my head it was because I was drinking a lot more water, it was hydrating and so that’s why I was going anyway, cut forward to do your point. Like I knew where all the bathrooms for cut forward to. I started adding some bio-identical hormones as initially as a patch. Then I reacted to the pattern so then it’s just as a lotion and I stopped going to the bathroom a lot and because it’s a lotion and so I’ve, I’m always minimized my dosage. And then, of course, I was traveling and I forgot the cube at home and so there was a whole week that I didn’t apply at all.
Reena Jadhav: Guess what? I started going to the bathroom a lot again in my husband comment. He’s like, wait, what just happened? You had completely stopped going and now you’re back to going more frequently again. And it’s so true, right? There’s, there is a connection with even just a slight bit of estrogen or a slight bit of bioidentical. That urgency can be gone and again, this is something that no woman ever wants to talk about. It’s just so embarrassing. So that’s why I’m talking about it. So we can all as a group talk about the fact that that’s a huge problem. Knowing where every bathroom is is a problem if it interferes with your quality of life. So I think the fact that estrogen can help with that means that we can all have some semblance of quality of life again for the decades more that we’re going to live after we had been a pause. One
Dr. Mache: thing I want to just add in before we move to the next chapter is that in addition to that, when you go from being a woman that’s entering menopause to a woman that’s been in menopause for a long time, if you’re not on hormone therapy in the vaginal area, you’re going to have an increased risk of urinary tract infections. As a result of that. You’re much likely to die from sepsis, which is what gets a lot of older women. I can tell you many stories about women who all we’ve done is put them on topical or local vaginal estrogen and cut out their continuing recurring bladder infections. This is a big issue for the older women that I see because they don’t realize what’s going on. And uh, me and my own mother, when she moved from one place to another, she had her to both of local estrogen last and the packing temporarily, and she got into a badge, dental infection. Then I put her in the hospital with sepsis and then she ended up getting and all kinds of things. That’s how people can die. And this is not just her. This is like this. It goes on every day in America. But anyway, let’s move to our next chapter.
Reena Jadhav: Thank you for sharing that. So next chapter, chapter nine, which is the estrogen fix for a fit, energized the body. Tell us the connection there.
Dr. Mache: Most important part here is to realize that estrogen is an important part in terms of maintaining muscle strength, in terms of maintaining the coordination that we talked about and just helps to maintain a healthy and fit you are going to help in terms of all the things. Here’s where you start putting together the sum of you and not just some of you because you’re working on your brain with the hormone therapy you’d been working on your muscles and helping with it because estrogen is going to help the sugars that you go into. Your muscles have better. It’s going to help keep the cells that it’s an instead of letting it redistribute to your belly, where women to get that mental pot, belly, belly, they don’t like that. Some of them are related. So, uh, all of these things, it helps with your asleep which is going to help the rest of your body. Because in the absence of estrogen, you start having a less rem, rapid eye movement sleep. And so you’re not as rested. And as in when I do see my patients in when I’d see them and talk about issues like for the menopause coaching that I do, all those things come up constantly, these lifestyle things or some of the things that keep them healthy and fit and they don’t know what to do. And so lifestyle keeping healthy and fitness, all part of the Estrogen Dick Story.
Reena Jadhav: Right? So now we get to the last chapter, chapter 10, which is talking to your healthcare provider about it. It’s one of the hardest things to do. I think Dr. Mache because we as patients believe that our gynecologist will proactively talk about it or let us know what we need to know. But that’s not the case, is it?
Dr. Mache: No, I mean the front of the people that I see, I give an hour for a new patient. Most people are getting about much less than that.
Reena Jadhav: Well, I can tell you what’s. It’s about 15 minutes and it’s the equivalent of a pap smear. And
Dr. Mache: how are you doing that? It takes time to go through a person’s whole story to personalize what it is you’re taking. When you go in, if you do have this book, the estrogen fix, if you do have it, if you read it, what you’ll find is what the North American Menopause Society said is not only recommended for patients but also for their doctors because of the references and there are 11 pages of index in the book that can help you find what you want. If you don’t want to read the whole thing, but you really need to come in proactively and be informed to become a partner in your healthcare because if not, you’re going to be having somebody who has their own ideas that may be good or bad and if your doctor is thinking that estrogen is bad for you, you have no chance to get it.
Dr. Mache: I have women that I have seen. I had one patient that came in. She decided she wanted to go to the heart to get hormone therapy. She went to a. A doctor who went to a really good medical school and graduated, but it was under this impression of estrogen was bad and she wouldn’t give it to her because she said, I don’t want to read about you and the obituary. So she was frightened to death. You also need personalization on which one of the estrogens is best for you. And I know there’s a lot of talk about bioidenticals and I do want to say very briefly that bioidenticals it means are not a real word. It’s not a medical word. It’s a marketing word and bioidentical implies that the structure of the hormone is the same as what’s made in the body bioidentical, but the bioidentical hormones that you get and compounding pharmacies do have some risk to it because in studies that have been done, what we have found is that when a prescription is sent to 12 different compounding pharmacies and that prescription is filled and sent to a chemical analysis lab, the dosages they are prescribed ended up being all different from each other.
Dr. Mache: With estrogen being as much as 80 to 200 percent higher than what was ordered. And with progesterone being as much as 60 to 80 percent lower than what was ordered, and this is just because it’s very hard on a one on one basis when you’re mixing it up one at a time to get it right and it’s not that they are making an error, it’s that the estrogen is put into a big Vat of a cream or something else and stirred up and just like when you put m and m’s in the vanilla ice cream, some scoops have more in some scoops, have less of those m and m’s and that’s the issue. Whereas you can get the same bioidentical hormones in a regular chain store drug store, and that’s every patch. Every one of those sprays gels, creams it is FDA approved the pellets and the ones in compounding or not FDA approved.
Dr. Mache: And therefore it is what it is. I’m not against them, but you’re Dr. Dan is going to have to check you carefully. You want to get a baseline evaluation of your uterus, a baseline evaluation of your bones. You’ve got to have an overview of who you are and then be ready to have a plan that’s personalized and it doesn’t end with that visit. You have to come back and see how it goes. Three months or two months and then again, and then once it’s more standard and once you kind of happy and then you can maintain what you’re on. So I’ll stop there, but it’s very important. This, this visit,
Reena Jadhav: I think it’s so important for us to know what we need to get tested. So could you just give us a quick checklist of what are the things I should walk into my gynecologist’s office and say, look, I’d like to do a bone density test? What else do you? You mentioned uterine lining test. Tell us a little bit more about what does it test we should be requesting.
Dr. Mache: It depends on. It’s a personal thing. It’s an individual thing, but generically you need to have a test that the uterine lining. If you’re going to get hormone therapy so you know where you are so you can see where it is. You might want to get baseline blood levels for your estrogen and your progesterone. You want to check your vitamin D level. So many women are deficient in Vitamin d today and that’s important for bone strength and muscle strength and for mood and everything. You have to get, uh, you will need some type of evaluation of your gi tract. I like to get colonoscopies on people at that point in time. Uh, you’ve mentioned the bone density. You might need to get a baseline EKG kg if is not getting done. Cholesterol levels checked for diabetes. There’s a whole workup depending on the individual and it just takes time to talk to that woman, talk to you personally and then to get what you need and make sure that everything is covered.
Reena Jadhav: Absolutely. All right. Any last piece of advice? Dr. mays for someone out there who’s suffering from a lot of symptoms and really wants to take charge of her life, what is the one big change she should make starting today?
Dr. Mache: I think the most important thing is to realize women are nurturers. They often nurture everyone else, but they don’t take time to nurture themselves, so I just want to say the time spent on you isn’t wasted or lost. It’s invested, it’s invested, and the Roi, the return on your investment is going to be a healthier and happier you and the quality of your life is going to be much greater if you take the time to take care of yourself because if you know, do like the airlines say and get the oxygen mask on you first, you can assist those who are traveling with you, so I would say take the time to understand what you need and then get what you need in order to live healthy, happy, and hormonally balanced.
Reena Jadhav: Beautifully said. Listen to Dr. Mache. She knows what he’s talking about. Prioritize your health. If you’re getting to those forties, you need to put your health as a priority. Make a list of things that read Dr [inaudible] Book. The link’s going to be available in our show notes and get ready to take charge of your health hormonally, and of course, we have the menopause bootcamp as well as the hormone health bootcamp. Check out those. They will help you. They’re designed by Dr. Mash. They include very specific recipes, workouts, meditation, supplements to make sure that you are going to have an amazing life. Thank you so much for joining Dr. Mays. Thank you so much.
Dr. Mache: It’s always great to spend time with. You will.
Reena Jadhav: Bye. Bye.
Mache Seibel, MD
Address: 233 Needham Street
Newton, MA 02464
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