What Science Says About Menopause, Perimenopause, And Hormone Replacement Therapy with Dr. Mache Seibel

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What Science Says About Menopause, Perimenopause, And Hormone Replacement Therapy with Dr. Mache Seibel – Transcript

Ari Whitten: Everyone, welcome back to the Energy Blueprint Podcast. I’m your host Ari Whitten, and today I have with me Dr. Mache Seibel, who is a women’s hormone, fertility and menopause, and hormone replacement expert. So we’re going to be talking all about those topics today. Real quick on his bio, his background, he has been selected by his peers as one of the best doctors in America, and he brings innovation to health education focusing on creative approaches to help America stay well. He’s a national expert in helping women in and around menopause, improve their symptoms, including sleep, stress, diabetes, and weight control. In addition to patient care, Dr. Mache does incorporate… does corporate consulting, speaking, workshops and coaching. He also has created Health Rocks, his unique brand of making health education fun and memorable using music and entertainment.

Also, there’s a quote from you that I want to read here because I really like it. Very simple, but it’s a powerful quote: “It’s better to stay well than to get well.” I love this because, you know, an ounce of prevention is worth a pound of cure as they say. I think it’s just so true that it’s so much better to be proactive when it comes to health rather than waiting until things spiral out of control and trying to reverse them. So with that said and with that wonderful quote to get kind of an intro into what you’re all about, welcome Dr. Seibel.

Dr. Mache Seibel: Well, thank you very much. I’m really delighted to join you and to have a chance to talk with you and to your audience.

Ari Whitten: Yeah, thank you. I’m honored to have you here. So I would love for you to talk a bit about your background because you have a unique story that you kind of started out in the fertility realm and then your personal circumstances transitioned more into a focus on menopause and hormone replacement therapy. So can you talk a bit about how that all played out in your life?

Dr. Mache Seibel: Yes, sure. I’ve always known I was going to be a women’s health specialist. I found it just fascinating. There’s just so much that can be done. And I started my career at Harvard Medical School in fertility in the infertility world, and I was very fortunate in the timing. I had the opportunity to do one of the very first in vitro fertilizations in the United States, the first in Massachusetts, one of the first to use ultrasound, etc. And I even was in People Magazine, written up for helping gorillas get pregnant at the zoo. That was one of my, that was my largest patient, I must say. And after that, shortly after that, when I was really at a peak of my career, there was a study that came out called the Women’s Health Initiative that suggested incorrectly that hormones could cause breast cancer in women, heart disease, dementia, and other things.

And millions of women threw away their hormones and thousands of doctors were afraid to prescribe it. And unfortunately just months after that study, my wife had surgery that threw her into early menopause and nobody wanted to treat her. And so I had to sort of stop what I was doing in the one arena and figure it out so she wouldn’t have to tough it out. And so I say I used to do sperm-to-term and now I do womb-to-tomb. So I do still see, in consultation for like second opinions and things, people in the fertility world, particularly women who are later in reproduction trying to transition or get that baby in. But also there are a lot of women now in this country who get thrown into menopause because of surgery that they have done to prevent cancer and other things.

Dr. Mache Seibel: So there are younger and younger women going into menopause in order to protect themselves from cancer. So now I’m focused more on the menopause side.

Why women experience going into menopause at an earlier and earlier age

Ari Whitten: So can you elaborate a bit about that, younger and younger women going into menopause? Let’s talk a bit about why that’s happening.

Dr. Mache Seibel: Well, one thing that’s happening, I mean there are… in a kind of an overview I mean, menopause is still happening in general around age 51. That’s the mean age in the United States. But if you look at menopause, which is the natural menopause at age 51, there’s still about five to 10 percent of women who go into menopause before age 45. That’s just what’s happening in the United States right now. And one in 100 before age 40, one in a thousand before age 30. So you know, you think menopause is about older women, but it’s not about age at all.

It’s actually just about to transition. Transitioning from reproduction into post-reproduction. And as I alluded to, the women who have certain genetic predispositions to certain cancers are being advised to get surgery done when they are 35 to 40 in order to prevent them from having ovarian or breast cancer. And as a result, we have several millions of women who have these genes and who are having surgery at this very early time. And they’re petrified because, you know, sometimes they haven’t had time to complete their fertility. Sometimes they have. But, you know, women are sometimes not marrying at a younger age. Many are going into professions and waiting until they’re later to get married. And so, you know, it takes time to find the right partner. So we have a lot of people who find themselves in a very uncomfortable position. Their solutions to that we could talk about, but still it’s tough. And of course, there’s a lot of things going on environmentally, too. There’s so many pollutants in the environment and so forth that are toxic and lowering fertility overall, environmental toxins and pesticides and a whole host of other things.

Why there is an increase in infertility today

Ari Whitten: Let dig into that a bit more, in the fertility side of things. Obviously, fertility and menopause are very much intertwined, but on the fertility side of things, infertility is becoming an epidemic both among men and women in today’s world. You just alluded to some of the reasons behind that, but can you talk kind of about maybe some of the statistics of rates of infertility and how they’re transitioning in the last few decades? And then what are some of the big causes of why there’s such an epidemic of infertility right now?

Dr. Mache Seibel: Well, part of it is really self-imposed. This is not the biggest reason, but it’s a reason and that is that as women delay childbearing longer and longer to keep their, you know, to find their work and to get their professional lives started, they find themselves working in, they’re starting to get pregnant instead of at 20 or 22 or 25, many women wait until they’re 30 or 35 and some are waiting until they’re 40. But the fact of the matter is that there’s a tremendous decline in the fertility of a woman after the age of 35. And after the age of 38, it drops again. After the age of 40, it drops again. After the age of 42 it has dropped really down to very low single digits. So it’s very important that if you know you’re going to have kids to try and plan your family soon as you can, what makes sense for you. But at least be mindful that many people are under the impression that “I’ve got all the time in the world. If I’m 35 or 40 it’s all the same.” No, it isn’t. And you just lower your chances for success, not saying you won’t.

There are other reasons, of course. The environmental things have gently lowered sperm counts and then over the last decades, and we’re seeing sperm counts dropping just uniformly. Normally about 40 percent of infertility is from the male, about 40 percent of infertility is caused by the female and about 20 percent there’s a little bit from both of the partners. Now the problems are… really if you break it down into why people can’t have kids, it’s for the woman, it’s either hormonal, the ovulation, the egg production is not ideal, or mechanical, the tubes, the openings of where the egg gets to the uterus to get fertilized, there’s blockage or scarring. There are things like that happened. And from the male it’s lower sperm count. That could be due to infection or toxins or some men are born with a blockage that doesn’t allow sperm to come out. And some women go into early menopause, as I mentioned, about one in a 100. And some men are born with really no sperm or very, very low sperm. So there are multiple reasons why it can happen.

Ari Whitten: Very interesting. And are you aware of any particular methods or natural therapies or lifestyle strategies that can impact this to a significant degree? Is it modifiable by lifestyle and nutrition habits?

Dr. Mache Seibel: Well, many things are, you know, many things are. But you know, stress is a big thing in our country today. Stress affects the women’s ability to ovulate and stress affects the male’s ability to produce sperm, and so stress is a real factor. Smoking is probably one of the simplest toxins to get rid of, excess alcohol or drugs, I’m talking about illicit drugs. Those are things that are very common today and that have an impact on reproduction and the quality of the woman’s ovulation, the man’s sperm count. Those are very modifiable. Being particularly overweight can be a problem and it’s also a higher risk of miscarriage for people, for women who are particularly overweight. Those are things that can be modified and are easy to, not easy to do, but doable. The thing that isn’t reversible is the changes that happened with the number of eggs as a result of a woman’s age because they decline over time and that is best handled by starting sooner.

Ari Whitten: Okay. On the point of the decline in fertility and the number of eggs that happen with age, if a woman is particularly health conscious, does that influence fertility? Is there any kind of data that we have comparing, you know, the number of eggs or the fertility levels in very health conscious, lean women with healthy lifestyle habits versus those who don’t have such healthy habits?

Dr. Mache Seibel: Well, let me just say that lean can be a problem. If you are a person who is struggling with bulimia and anorexia, sometimes there’s too little food intake and you need the proteins in order to make the hormones to ovulate. So too little weight is also a problem. Too much weight is a problem.

Ari Whitten: Absolutely.

Dr. Mache Seibel: But of course people who are healthier, who eat healthier, who exercise, who quality control their stress, who are trying to get enough sleep. People who do those things are going to be healthier and everything they do is going to be easier from a health point of view, no question. But the problem is that today we have such tremendously great technology with in vitro fertilization and injecting sperm into eggs and all the new things that are out there that many people are under the assumption that “I don’t have to worry about it at all.” But I’m trying to raise awareness by speaking with you is that that’s only partially true and that in fact, you can wait too long so that the best technology in the world may not be able to help you.

So I’m just putting out a red flag and just saying, “Hey, if you take care of yourself and you try to have your kids at a reasonable time meaning, ideally 35 or under, you’re going to probably do fine. And if you start waiting longer and longer then you may still do fine. But (a) it’s going to take longer and (b) it’s going to happen less consistently.”

Ari Whitten: Very interesting. Do you, just out of curiosity, do you envision any significant breakthroughs in the coming 10, 20, 30 years as far as in vitro fertilization and the ability of otherwise infertile couples to have a baby?

Dr. Mache Seibel: I think today it’s impossible to think 30 years ahead because the changes are happening on a hockey stick kind of a change. The rapid rate of change is just so great. But, you know, the biggest thing that’s happened in the last year or two is that women are now able to freeze their eggs and the eggs can be thawed and be successful.

So when you’re married and, or you have a partner, and you fertilize an embryo, meaning the fertilized egg… for years now we’ve been able to take, you know, the fertilized egg, freeze it, thaw it out and have very good success rates. But it’s only recently that single women or women who don’t have a partner have been able to fertilize, to have an egg extracted and just the egg frozen. Because remember an egg is just one cell. It’s the largest cell in the body, it’s huge. You can see it with your naked eye, so it’s big for cells. But it’s only one cell. And so if anything goes wrong with the egg you lose that potential for pregnancy. But now it is possible to consistently take out eggs, extract them with a fine needle and then freeze them. And then later on when you have a partner, or, you have a partner, you have one child or no child, but you have to have surgery to have your ovaries removed at a young age because you’re trying to prevent cancer or whatever the reason. Maybe you have cancer and you needed radiation or something like that. Now you can take the eggs out ahead of that. Just like men can freeze sperm, women can freeze eggs. I think that’s probably the biggest thing that’s happened and it’s only been in the last couple of years. But you still have to pick your centers carefully. Not everyone is the same quality, so that is probably the biggest thing.

What is menopause and what happens at a hormone level when you reach menopause?

Ari Whitten: Very interesting. So let’s transition now from fertility to hormone replacement therapy, menopause. Obviously, this transition happened for you in your own life due to the circumstances with your wife and then you went from being an expert in fertility and in vitro to an expert in menopause and hormone replacement. So kind of, you know, I guess let’s go real basic here to start with. What exactly is menopause and what happens on a hormonal level?

Dr. Mache Seibel: Well, menopause is defined as one year after a woman’s last menstrual period. And I’ve mentioned it typically happens at 51, but it can happen at any age. And the symptoms for that startup to 10 years before. So you’re being, you know, here you are, you think you’re fertile and then you’re suddenly having hormonal fluctuations transitioning into menopause. But what happens is as the number of eggs in the ovary dwindle, and you see a woman is born with all the eggs she will ever make, and then over her lifetime, that number diminishes. So as a fetus, when she is a fetus she has like 7 million eggs. By the time she’s born, it’s down to about 400,000 and then those get used up every month after age 13 or 15 or whenever she goes through puberty. And then every month 20 or so come forward and that number diminishes over time until they’re all gone. And when they’re all gone, then the estrogen and progesterone they make are also gone.

So you go from very high hormone levels of estrogen and progesterone, which are the things that really, not only are for fertility, but they affect mood and they affect skin and they affect bladder and intimacy and all kinds of things, those hormones suddenly go from very high to basically almost zero. And when that happens, the body reacts by being, by missing those hormones. And so that’s what causes all the symptoms. And we have to remember our purpose in life from a biologic point of view is to have children and reproduce. And if you think to, in 1900, which I guess was a long time ago, but in evolution not so long ago. In 1900 the people didn’t live beyond age 48. I mean, that was kind of the life expectancy. Of course, some people lived to be 60, 70, 80, but they weren’t many because there was no antibiotics or anything like that.

And if you got pneumonia, you died. Things that were very simple would kill you. So today most women are going to live to be 81 and many are going to live to be 90. One hundred is the fastest growing age group in America. So people are living longer and longer and longer. And so they’re going to be asking their body to stay well beyond menopause for more and more and more years. And that’s why the hormone therapy can be helpful, but some kind of therapy, doing something is very helpful.

Ari Whitten: Okay. So, what is it, kind of, what do estrogen and progesterone look like in a young woman with a menstrual cycle? Can you, I know this is complex and there’s a lot of subtleties to this, but can you give kind of a basic oversimplification of what the fluctuations in estrogen and progesterone look like in a woman who still has a menstrual cycle versus what happens after she goes through menopause?

Dr. Mache Seibel: Sure. Let’s think about what happens to a woman at puberty. You know, now you’ve got a girl who’s prepubertal. She’s flat chested, many times kind of looks like a boy or a girl. They all look about the same when they’re younger. And, you know, her body is kind of up and down and she has no real thoughts about sex or sexuality or any of those kinds of things. And then what happens is she starts to have puberty. And then what happens? Well, breasts start to grow. Curves come to hips, skin gets shiny and fresh, thoughts happen in her mind about the opposite sex or sexual thoughts happen. And her body changes and evolves from one, you know, kind of a neutral place of low or no hormones up to a fully estrogenized or fully hormonally imbued woman. And it stays like that for, you know, 30 years or so.

And what happens is, you know, during that transition your skin starts to get some acne because of all the confusion of your hormones and all that is going on. And then that all smooths out. And your cycles get very irregular and they start and they stop and then they start to get very smoothed out. All that’s going on. Then you get to the other side and it’s like puberty backward. And what ends up happening is that there’s less tissue to the breast. So the breasts start to change in their consistency. There are fewer hormones in the brain. So there may be brain fog and there may be less interest in sex or sexuality. Menstrual periods start to get a little bit wonky and then eventually they go away. Hair may grow in places it didn’t use to, on the chin or along the brows and so forth. So there’s a real change in the hormones and the impact of the hormone on a woman emotionally and physically and reproductively.

How estrogen hormone replacement therapy can help women feel better

Ari Whitten: So my sort of understanding of this is that, you know, maybe in the past, when lifespans were generally shorter, maybe this wasn’t such a huge deal and we didn’t have that many years of life post-menopause. Whereas now, since we have so many decades post menopause, this is becoming a bigger and bigger deal than it used to. So it’s sort of more of a priority to find ways of living healthfully and feeling good post-menopause than it used to be. And I think this is kind of where hormone replacement fits into this, right? The whole idea behind hormone replacement, estrogen replacement therapy was we can help women feel better and feel more like they did when they were younger, rather than suffering some of these symptoms of menopause. Is that an accurate sort of overview of all this?

Dr. Mache Seibel: It is, and I think that the issue is that because of the study I mentioned earlier, the Women’s Health Initiative study, which was inaccurate. And I’ll explain why in a moment. Women avoided taking hormones because they feared for their health. It was kind of like Russian roulette. You thought you might feel better, but you risked breast cancer and other conditions. It turns out that’s not necessarily so. But what happened was because of that study, doctors stopped prescribing it. So what we find is that today there are 8-0, 80 percent fewer women taking hormones than they did in 2002. And that’s because of two things, women’s fear and doctor’s fear. And then what has ended up happening is because there are 80 percent fewer women taking hormones, there’s not as many people proficient at prescribing them because the doctors in training for the last couple of decades have not gotten any training.

A matter of fact, what I’m doing at Harvard Medical School at Beth Israel Hospital is not only seeing patients in perimenopause and menopause, but also helping to train the doctors in training because they’re unfamiliar and they don’t see those patients themselves. And it’s one of the reasons that I ended up writing my book, “The Estrogen Fix” and one before it “The Estrogen Window” because this explains it in simple terms. And what I’d like to do is just briefly explain why they got it wrong, this very well intended study. Because what they wanted to do was to prove estrogen was helpful and they thought it was because it seemed to be beneficial. But when they went to do the study, they enlisted thousands, tens of thousands of women. But because estrogen was the number one medicine prescribed in the United States at that time, it was a $7,000,000,000 hormone.

They couldn’t find any women who weren’t on it. And so in order to fill the study, they took women who were in their sixties and seventies and gave them hormones. And they compared these women in their sixties and seventies to women with a placebo who were in their fifties, who they didn’t give the hormone. So they compared these older women to these younger women. And what they found was women who were in sixties and seventies have more health issues than women who were in their fifties. Well, that’s what you would expect.

Fortunately, about 25 percent of the patients were all in their fifties. And when they took the two groups with hormones and without hormones, and they superimposed them so that everybody was in their fifties, there wasn’t almost any difference between whether you took it or not. But it took them almost a decade and a half to sort out if the same patients… They took the same women who were in that first study and just culled out the ones of the same age. In doing that, they figured out that it’s not hormones that’s a problem. It’s the estrogen window, it’s the window of opportunity. And when you do that, you make things very different.

We now know that women who take hormone therapy actually live longer, even in that original study. If they take it, they have a lower risk of heart disease. They have, if they take estrogen-only they actually have a lower risk of breast cancer, 23 percent lower risk of breast cancer. If they need estrogen and progesterone, in other words, if they have not had a hysterectomy, then it’s about the same is whether you take it or not. And of course, you lower your risk of colon cancer, you lower your risk of hip fracture and osteoporosis, you lower your risk of diabetes. There’s a lot of benefits from taking it. But even if you don’t take it, the thing I want to encourage you to do is to do something about your symptoms because they are having an impact on you.

Ari Whitten: Okay, I want to try and recap this from a slightly different perspective. So estrogen replacement therapy or hormone replacement therapy came into existence what in the 1980s, ’70s, ’90s?

Dr. Mache Seibel: It actually was developed in 1942, but in the fifties is when it really became, you know, more available.

Ari Whitten: Okay. So in the span of several decades, it was very popular and there was emerging data showing things like it helped with hip fractures and bone loss and risk of various other conditions, heart disease, and also subjectively made people feel better and eliminated some uncomfortable symptoms like hot flashes and things of that nature. So there was sort of this very positive vibe around it. People were feeling good, the data was looking good. And then in 2002, there was this sort of big bombshell study that came out, the one that you were referring to, where they did this analysis, tens of thousands of women. And then it made huge headlines in all the media, the major media outlets in the country, maybe in the world, but certainly in the United States, showing that women on hormone replacement had higher risk of all these conditions and were more likely to die of breast cancer and things like that. But what you’re saying is basically they screwed up the analysis and it wasn’t a fair comparison because they’re comparing older women to younger women, older women on the hormone replacement to younger…

Dr. Mache Seibel: It was a bad study design.

Ari Whitten: Okay. So, and then when they did a reanalysis of that same exact study that showed that, they actually found that women of the same age group in their fifties were protected or at least had sort of the same health outcomes, there weren’t any health detriments.

Dr. Mache Seibel: More or less the same outcomes. The thing that where this becomes really important is for those women, the five or 10 percent of women who go into early menopause. Because if you’re in early menopause, meaning age 48 and under, but definitely age 45 and under, and you do not take hormones, or do something for it, then you do increase your risk for heart disease, for emotional health, for hip fracture, for a whole host of conditions. And there you’ll have to take estrogen from the time of early menopause, not when you’re 50, but if you go into menopause at 35, you start it then. If you go into menopause at 40, you start it then. And if you stay on it until you’re 50, 51, which is the age of natural menopause, almost all those increased risks of being in early menopause go away. So it’s really important for those women, particularly these young women who have to have surgery and go into menopause because of risk, you know, cancer prevention and so forth.

What science has found out since 2002

Ari Whitten: Gotcha. So are there, is there any sort of… Well, actually before I ask that question, I have another question. We’re talking about data from 2002 so far. I’m curious, there have obviously been 16 years from then until now. What does the data, you know, from the last five or 10 years show as far as, you know, examining hormone replacement therapy and various sorts of health outcomes?

Dr. Mache Seibel: Oh, it just keeps piling up on the… once the mystery was cracked on this estrogen window, once the investigators understood that when you started is the single most important point of hormone therapy. Now the results are amazing. I mean, it’s really helpful in controlling heart disease, improving sleep, improving sexuality, preventing dementia, bladder control, osteoporosis, longevity. The data is coming out, as I said, you know, I read dozens of articles every month, that are brand new, reinforcing this, but more and more nuanced information. I mean, when I’m talking to women that I coach through menopausecoaching.com, and when I have people that I’ve talked with, one of the things that they really want to know about is how to take hormone therapy. Is it safe to take it? You know which type, how much, how long and so forth? These are things that people are trying to sort out because, what’s happened is because the fear was so great. What happened is that the fear is not rational, and once you have something that affects you emotionally, that you fear, then it’s very hard to undo that because you’ve been hearing all this stuff and what I’m saying is that there’s tons of data, reams of data.

In my book “The Estrogen Fix” I have references in my book that go explain every one of the things that I’ve done, all the papers that lead up to it. I mean it’s been recommended not only for patients but also for doctors because it’s so well referenced. Now you don’t have to read those references. I tell you what it says, but if you wanted to, you wouldn’t have to take my word for it. You could go look at those papers and you would see the data is there. But you make a good point. It wasn’t like they just took that one bad study, and made it good. Study after study after study over the last decade have, once they have understood timing, then everything changed. If you continue to start it later, if you wait until you’re 65 and start taking it, it’s not, what I just said is not true. It can be problematic. It does increase the risk of heart disease. It can increase the risk of dementia. It can increase the risk of bladder problems. There are things that can happen if you don’t start it, because your body has been aging for 15 years and then you’re adding in something on top of that. Now that’s a different story.

Ari Whitten: So this is now getting at the concept of the estrogen window that you’re talking about. It’s basically, that general concept is basically if you go into menopause and then you wait 10 or 15 or 20 years and then you start the hormone replacement therapy, there’s a different set of health outcomes that are associated with that situation than if you go into menopause and then sort of immediately get onto hormone replacement therapy within what, 5 or 10 years?

Dr. Mache Seibel: Totally different story

Ari Whitten: And it’s within 5 or 10 years of going into menopause. What is the actual time window?

Dr. Mache Seibel: Optimum time is within 10 years of… But either in your fifties or within 10 years of starting menopause.

Ari Whitten: Okay.

Dr. Mache Seibel: And another thing that I have done for in terms of the public is I also have this magazine called “The Hot Years” which is a digital magazine.

Ari Whitten: It’s a great name, by the way.

Dr. Mache Seibel: Thank you. Yeah, it’s available and I want to give this to all of your listeners free. It’s hotyearsmag.com. We have very interesting interviews, but we have recipes and we have exercises. This latest issue is the woman who is the founder of Zumba Gold. Some of you are familiar with Zumba Gold.

And, you know, we have topics like cardiac risk factors, find your lost libido, anti-aging exercises, you know, but there’s also a whole host of things because I believe that if you want to stay well as you age, you have to start and develop good habits. And you have to take care of, what I say, you take care of the sum of you and not some of you.

Very important that you realize that you are the sum of your parts and that you have to deal with your emotional needs, you have to deal with your physical needs, you have to deal with your lifestyle needs, you have to figure out what’s the best treatments. If you’re not going to take hormone therapy, there are alternatives to hormone therapy that I talk to people about because they need to take their symptoms seriously.

Because, for instance, if you take something like hot flashes, hot flashes are the most common symptom. They are a real nuisance. And 80 to 85 percent of women have hot flashes. These things at first glance just seem like, “Well, you feel warm. What’s the big deal?” But it turns out that women with hot flashes that do not treat them end up missing work on average about six times a year more than women who treat their hot flashes. And so as a result of that they’re also not sleeping as well. And as a result of that, they’re also not performing as well at work. And so there are all these different studies that give data to explain that if you’re treating your hot flashes, you’re not a wuss, you’re not somebody who can’t tough it out.

What you’re doing is you’re figuring it out so that you take care of yourself optimally, and you take care of the quality control of your life and you sleep better, you feel better, you perform better at work, you go to the doctor less often. Just from hot flashes.

Why many women feel they need to ”tough” menopause

Ari Whitten: And, you know, there was one thing that we were chatting about before I started recording that I thought was a good point. You mentioned how the women’s movement has kind of influenced this in a certain way where a lot of women who are experiencing these symptoms feel a desire to, they feel like they’re pressured to just tough it out rather than actually doing something about their symptoms because they might otherwise look like a wuss, right?

Dr. Mache Seibel: Exactly. So many women tell me, you know, “I can tough it out. I can deal with this.” Of course, you can deal with it. “Why would you want to?” is the question. I mean I don’t question it, but why? Especially if you realize that treatment options are really not putting you at increased risk, which is the misconception, or as I call it, the “myth” conception. Because people have learned to fear these things. And if you just won’t take hormones or you can’t because they’re going to be some women who have breast cancer or other conditions and you can’t take it. Okay, I understand that. But there are treatments, there are alternative treatments that you can do. And I talk about those in my book, “The Estrogen Fix.” But there, it is very important that you deal with these symptoms for your quality of life.

Why a holistic approach is essential when doing hormone replacement therapy

Ari Whitten: Okay. I have a little bit of a tough question for you. There are some people who come from a more naturalistic paradigm, and I include myself as one of those people. Not necessarily on this issue, but more broadly speaking, who might look at this and say, “Well, why are humans designed biologically to go into menopause, to lose their fertility, to have this decrease in hormones at this particular age? It’s natural. Shouldn’t we honor this from a biological, evolutionary standpoint? Shouldn’t this be honored?” And the second part of that question is, is there any sort of known tradeoff between, maybe if you do use estrogen or hormone replacement therapy after menopause, maybe you feel better subjectively. Maybe there are various health endpoints or disease endpoints that we can show benefits for. But is there any sort of trade-off where maybe you have worse outcomes in some other area?

Dr. Mache Seibel: Well, to the first, you know, personal views are very important and we have to be open and I try to look at people who come in as individuals and holistically. So if you have a personal preference that hormones are not for you, that’s okay. What I’m advocating here is not that you must take hormones. I’m saying there’s a lot of benefit from taking them and that if your reason for not taking them is fear or worry or confusion, that that can be explained away. If on the other hand, you feel that that’s not what you want to do, I get it. So that’s where the alternative things come in. Now for every woman, whether or not she takes hormones, it’s very important to focus on four lifestyle changes, or four lifestyle issues. Number one is to lower your stress. That’s the number one thing.

: Stress is killing this country and it’s just… I’ve been watching, you know, the news and just the news are very stressful. You never know what’s happening next and there are so many things, but stress, you know, people are working two jobs, people have kids with issues, older parents. Women in menopause often, just if the kids have no problems, they’re just normal kids and you’re carpooling back and forth, you’re trying to go to work and you’re trying to deal with your parents who are aging. Life is tough, but stress reduction is essential. Number two, exercise. You don’t have to run the Boston Marathon, but you have to get up and do something every day, even if it’s just 15 minutes every day, but you got to do something. Ideally, you could do 30 minutes, five days a week and that would be ideal. But exercise, that helps to control stress, it lowers the risk of depression, it lowers the risk of breast cancer. Exercise is good for you.

The third thing is that you’ve got to get enough sleep because people who don’t sleep have a lot of trouble. Their body works against them. They increase their risk of blood pressure, heart disease, diabetes, and also obesity because hormones that control weight happens when you sleep. It’s kind of like when the tree has lost its leaves, that doesn’t mean it’s dead. It’s doing something in that dormant state and then it’s going to bud in the next spring. So we’ve got to do the same with ourselves every night. It’s detox and a cleansing time of our life. Our cells clean themselves at night. And then we’ve got to eat healthy. We have to choose foods that are not packaged or processed and not too much sugar and not too much salt and we have to be mindful of eating really healthy foods. So those four things, sleep, exercise, stress, and nutrition. That’s important whether or not you choose to take hormones. And then there are all the alternative treatments. And they can be anywhere from, you know, herbs to cognitive behavioral therapy treatments to acupuncture to yoga. And there are all kinds of things that you can recommend for people to help. And so people don’t have to feel trapped between hormones and nothing. I’m just trying to say that if you feel that you can consider hormone therapy, don’t avoid them through fear of an adverse effect.

How to learn more about hormone replacement therapy

Ari Whitten: Excellent. So are there any sort of concluding thoughts that you want to leave people with? And actually, one more question that I’d like to ask you, which is on the technical side of hormone replacement therapy, are there doctors who are doing things in different ways? And if somebody is now, let’s say that after listening to you speak on this interview, if they’re now open to doing hormone replacement therapy, whereas previously they weren’t, is there anything they need to know about what kinds of doctors or types of hormone replacement therapy they should seek out or not seek out?

Dr. Mache Seibel: Well, I would get somebody who is familiar who… there is, the North American Menopause Society has a list of menopause practitioners and I am certified by them as a Certified Menopause Practitioner. But I’m also board certified as a Reproductive Endocrinologist. And that includes hormones and everything. But you want to get somebody who really specifically understands this. I can tell you, I talk about hormone therapy. I do speeches around the country to both medical groups and to lay groups. There’s a lot of pushback still from hormones because there’s a lot of people who understood it in 2002 that there was a problem and they didn’t figure anything out since then. And there’s a lot of pushback still. So I would say that probably about half the doctors out there are going to be reluctant to treat even today with all this data.

Ari Whitten: So it’s very possible that somebody might listen to this podcast and say, “I heard Dr. Seibel say that hormone replacement therapy is not something to be scared of and that the data is overwhelmingly in support of benefits.” And they may go to their doctor and explain that and say, “I’m interested in doing hormone replacement therapy.” And it’s very possible that their doctor may say, “Well, you know, it’s dangerous and you should avoid it. And whoever you heard that podcast with is wrong.”

Dr. Mache Seibel: Yeah, there’s a good chance. A lot of my patients buy my book and take it to their doctors and I’m not joking about that because it’s a really big, it’s a real big issue because the data is confusing. But once you sort this out, and I’ve made it very simple, I mean I’ve distilled it down very simply. But there’s a lot of little steps in this and a lot of nuances. But fundamentally the majority of women can safely take hormone therapy and I would say about half the doctors in the country will still be resistant to it.

So, I think you just have to be an advocate for yourself. I think that it’s very important that when you have a symptom and a need, that you have to seek out people who are knowledgeable, who can help you. And you know, if you’re, if you… I do. Because there are people from around the country who can’t come and see me, I do menopause coaching as I mentioned, menopausecoaching.com if people are interested. And the thing that’s important about it is, whether it’s me, or whoever it is, what really matters is that you understand what your options are.

You understand what your body is optimized by. You have to take into account your personal preferences or your limitations in terms of conditions that you might have and so you may have only option A and not option B or whatever it is, and then you get what’s best for you to take care of the sum of you. What’s important is you realize there’s a lot of information, a lot of options. It’s your life and you’re likely to be living a third of your life after menopause and you want those years to be healthy, happy and vibrant, and the best way to do that is to find out what works best for you.

How to balance your hormones naturally

Ari Whitten: Yeah. One more quick question. You mentioned some natural therapies, obviously those four key habits that you should do whether or not you’re doing hormone therapy. Then you also kind of mentioned in passing some alternative therapies, whether acupuncture or yoga or meditation or various other things that might be available. Is it possible or feasible in your view that someone could maintain a sort of relatively decent hormone balance and be mostly symptom-free if they have enough of those kinds of healthy habits? Or are we looking at just sort of a minimal effect of managing some of these symptoms that don’t compare at all to hormone replacement therapy?

Dr. Mache Seibel: Well, there’s two parts to what you’re asking. And so let me, let me try to address it. I think that the benefit of estrogen is that it treats all the symptoms. So almost everything gets taken care of in kind of one fell swoop. Now, if you choose not to or can’t take hormone therapy, I believe that you can live a very satisfactory and fulfilled life and feel good without it. But you’re going to have to divide your body into its parts and then you’re going to have to find appropriate treatment for each of those. You have to do things to protect your mind, things to protect your skin, things to protect your bones, things to protect your bladder, things to protect, you know, each part of you and each of the symptoms. And it’s just a matter of putting the effort into identifying those products or those behaviors or those foods or those exercises or those, whatever it is, you know, supplements, whatever it is.

But it’s just a combination and so you just have to have somebody work with you to deal with each of the parts. Because, as I said, you’re the sum of you. You either go to the pill or the patch, or whatever form of hormones goes to all of you. That’s not to say that if you don’t do… you can’t take hormones and then eat bad food and never exercise and stay up all night and smoke cigarettes all day and stress out all the time. Hormones aren’t going to save you. Boy, if you think that’s the case, you’ve got the wrong notion. It’s all of this stuff. But if you don’t take hormones, you just have to find the… you have to look at this system of you, all of you and treat each of those independently.

Ari Whitten: Got you. So to conclude, is there any sort of overarching tip or message that you’d like to leave people with?

Dr. Mache Seibel: I would just say from the first part of our conversation, if you’re thinking about having children, have them early as you can. And don’t think that technology will save you even though it can bail you out sometimes or many times. From the menopause side, I would say that find a practitioner who is clear and understands the hormonal side of things, but also the alternatives to it. And just realize that time spent on you isn’t lost. You are investing, you’re investing in yourself. And so I think that it’s well worth putting the time in. And I do want to remind you, I’d be very happy to give you a free subscription to “The Hot Years” magazine, hotyearsmag.com. Just go. It’s digital, but it works on all the platforms and just download it and enjoy it and take advantage of it. And I’m happy to hear from you if you have questions or other issues.

Ari Whitten: Excellent. So for people who want to learn more about your work, go get your book on Amazon. It’s called “The Estrogen Fix.” Right? And then you have hotyearsmag.com where they can get a free subscription to your magazine and you also have your website. You also do menopause coaching, right?

Dr. Mache Seibel: Yes, that’s true.

Ari Whitten: Okay. And what’s the name of your website?

Dr. Mache Seibel: drmache.com. d-r-m-a-c-h-e.com.

Ari Whitten: Excellent. Well, thank you so much, Dr. Seibel, it’s been an absolute pleasure to do this with you and I really appreciate your time and you sharing your wisdom with my audience.

Dr. Mache Seibel: Thank you so much for having me.

Ari Whitten: Yeah, thank you.

 

What Science Says About Menopause, Perimenopause, And Hormone Replacement Therapy with Dr. Mache Seibel – Show Notes

Why women experience going into menopause at an earlier and earlier age (4:28)
Why there is an increase in infertility today (6:42)
What is menopause and what happens at a hormone level when you reach menopause? (13:30)
How estrogen hormone replacement therapy can help women feel better (22:13)
What science has found out since 2002 (30:39)
Why many women feel they need to ”tough” menopause (37:08)
Why a holistic approach is essential when doing hormone replacement therapy (38:25)
How to learn more about hormone replacement therapy (43:05)
How to balance your hormones naturally (47:13)

Links

Sign up for the ”Hot Years Magazine” here

To work with Dr. Seibel, go check out his site