Mache Seibel, MD, Author of The Estrogen Window and The Estrogen Fix, Beth Israel Deaconess Medical Center, and Harvard Medical School, talks about estrogen therapy for women going through menopause.
Interview conducted by Ivanhoe Broadcast News in September 2017.
So, women hit that early to mid-fifties age and they go through menopause. It can be really tough, what do you think about that?
Dr. Seibel: While the mean age of menopause is 50, one in about five to ten percent of women will go through menopause at age 45. However, the symptoms start ten years before that occurs. Menopause is not about age; it’s about the transition.
Did you say six thousand a day?
Dr. Seibel: Six thousand women a day will go through menopause, that’s two million women every year. That’s a lot of women who are struggling with what to do. It is a lot of discomfort and a lot of confusion about what their options and best choices are.
So most doctors across America don’t want to give these women hormones, why is that?
Dr. Seibel: In 2002, a study came out that incorrectly stated that hormones, and we’re talking estrogen and progestin primarily here, cause breast cancer among other chronic diseases like heart disease, dementia, etc. But a reevaluation of that data as recently as September 2017, showed that that’s not the case. In fact, all-cause mortality; death from cancer, death from heart disease, none of that is different if you took hormones.
What is it that you believe?
Dr. Seibel: I believe that menopause comes with many symptoms and that most of those signs can be benefitted with the use of hormone therapy. I also think that the majority of women would be good candidates for it if they start it at the right time.
What is the right time?
Dr. Seibel: The right time is what I call the estrogen window. The estrogen window starts from the beginning of menopause and continues roughly for about ten years. If you begin hormones in that window, then most of the treatment will be very safe. But if the window closes, then that may be different.
What are the health benefits?
Dr. Seibel: Estrogen can lower the risk of breast cancer by 23 percent. It can lower the risk of heart disease by 32 percent. If you’re a woman that goes into early menopause, meaning before age 45, your risk of dementia is increased, and you can have up to a seven to 70 percent increased risk of dementia. Estrogen eliminates these problems. You have an increased risk of diabetes without hormones, an increased risk of osteoporosis, colon cancer, etc. There’s a whole host of things. Why not allow yourself to feel better, while also helping your body to live better?
So by taking these treatments while you’re in early menopause what is that doing to the rest of a woman’s life?
Dr. Seibel: Well, it’s giving you the opportunity to reduce the likelihood of cardiovascular or heart disease, osteoporosis, diabetes, colon cancer, a whole host of conditions that are common chronic conditions, and also to live a happier, healthier life. It’s going to help you to sleep better; it’s going to help you to have less brain fog. It may have a benefit on libido; there’s a whole host of things that start at your head and work their way down.
So why don’t more doctors give it out?
Dr. Seibel: Unfortunately, there’s a lot of fear and confusion around the hormone therapy because of the 2002 studies which have been refuted over and over again. The data that supports the original research was wrong. Not everybody can synthesize the information in the journals, so I wrote The Estrogen Fix.
Is Karen a good example, and why?
Dr. Seibel: Yes. Karen came to see me because she had many symptoms that are typical of women in this age bracket. She was going through menopause, and she wasn’t sure if the hormones were safe based on what she heard from different people. When she gathered all the facts, she could understand that this was based on science that’s in the top journals in the world; she could see the benefits, which led to her getting the treatment.
Are you’re telling me hormones are safe?
Dr. Seibel: For the majority of women, yes I believe that, and so do many of the experts in this area. Hormones are safe for the majority of women, if you start them at the right time, and if you individualize it.
Who shouldn’t do it?
Dr. Seibel: Women who have breast cancer, for the most part, are not good candidates. Women who have undiagnosed bleeding, women who are pregnant, women with liver disease, there are several conditions in which it is not optimum to take these hormones. Of course, there’s going to be some women who just don’t want to take it for personal belief or whatever reason, but there are other things people can do.
Why did you write the book?
Dr. Seibel: I did this book because my wife went into early menopause from surgery, just months after the women’s health initiative was published. Her doctors didn’t want to treat her with hormones, and at that time, I was one of the country’s leading experts in infertility. I shifted, I used to do sperm to term, and now I do womb to tomb. I shifted to menopause because I had to figure it out so she wouldn’t have to tough it out. Now I want to take this information to as many women as I can.
What else do you want to tell me about this and why should we do it or why shouldn’t we do it and who should we go to?
Dr. Seibel: I think that if you want to get help, you have to find someone who’s knowledgeable in this area. The generalist, some of them are terrific and know, but some of them are not. Also, there are 80 percent fewer women taking hormone therapy today than there were in 2002. As a result, there are 80 percent fewer experiences with treating menopause or prescribing hormones. So you just need to find someone who is familiar. There is a certified menopause practitioner status through the North American Menopause Society, of which, I’m a part of. There are others around the country, but get somebody who’s knowledgeable.
So is it risky for a woman to start that treatment?
Dr. Seibel: No, every medication that you take comes with risks and benefits. However, the benefits are greater than the risk. My belief is the data shows that for the majority of women, the benefits far outweigh the risk.
Is there anything else you want to say?
Dr. Seibel: I want to be clear that I am not sponsored by any drug money. I’m not here for any other reason except I saw the reaction my wife got when she went to get treatment; there was general concern and fear. They were doing it out of care and the belief that they were right. But the data has changed, the pendulum has swung. If someone doesn’t want to take estrogen, that doesn’t mean they can’t be healthy, or they won’t have a happy life. It means that they have to work hard because they have to take extra care of each part of themselves and just be proactive.
Your body creates this when you’re younger right, so you’re just putting it back in because nature is taking it out?
Dr. Seibel: Yes, remember that in 1900 the average woman was living to be 48 years old. Menopause is a phenomenon of our success as a nation to live longer. Now, a woman can expect to live a third of her life after menopause, and that means in the absence of hormones. Hormone therapy is just extending what nature was doing up until the point of menopause, and then after every five years, let’s say, makes it a renewable option.
And if you start to get this is it as simple as a blood test?
Dr. Seibel: A blood test can tell you if you’re approaching menopause. A hormone called FSH or follicle stimulating hormone will rise as a woman gets closer to menopause and away from her reproductive years. That is how we will know.
If we started the treatment how do you maintain it, is it as simple as a blood test to get this going, how does it work?
Dr. Seibel: Well every exam, every medication that’s begun should be started with a history of a physical exam. A blood test is done, and then you can start at a very low dose, and for many women, some are enough, if not you can just give them more.
So you gave this to your wife, you’d give this to your family members, no worries?
Dr. Seibel: Well I got the data, so that she could get it, and find a doctor who would be supportive of it. But yes, I’m perfectly comfortable with the notion of it.
She takes it as a patch is that how you normally would do it?
Dr. Seibel: I typically give it as a patch as a choice because there is some slight lower risk of blood clotting with the patch and but lower dose oral pills can be safe too. So it depends on the individual. Estrogen comes as a pill, as a patch, as a spray, as a gel, like cream; there are all forms of it. One of the questions that people ask about and I don’t think you’ll have time in this interview but they ask a lot of bio-identical hormones and the reason I mention that is because people don’t realize they think that bio-identical hormones only come from compounding drug stores. But in fact, you get the same hormones at the regular chain store drugstores; it’s the same estrogen. But there its FDA approved under strict criteria that the dose you buy is the dose that you are supposed to get.
So you’re saying a generic form versus the non-generic?
Dr. Seibel: No, no I’m not. I’m saying that if it comes from a standard drugstore, the supplier had it specifications approved by the FDA for the manufacturing of it; whereas in a compounding pharmacy, it’s not FDA approved. That’s a side issue, and I wouldn’t go there because I think it’s too much. But it’s a really important link because the women on the bio-identical think that they are engaging in safe activities are now coming down with uterine cancer.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Teresa Herbert
Mache Seibel
617-916-1880
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