Busting The Estrogen – Breast Cancer Myth

Deb Matthew, MD

Thank you. It’s so great to be back here talking to you.

Jennifer Simmons, MD

I’m so happy to have you here. It was at my last summit just about a year ago that we first spoke and talked about all of this hormone stuff. What is the real truth? Because it’s hard to find the truth. It’s hard to figure out what’s true and what’s not. We’ve been painted a very contrived picture. It takes a true person, a true truth seeker, to find the truth. I want to start by telling your story because it’s one that so many women relate to.

Deb Matthew, MD

Sure. Well, I used to be tired all the time. Napping was my favorite hobby, and I was cold all the time, even though I live in North Carolina. I would still take a sweater with me in July because when I’d go into air-conditioned movie theaters and restaurants, I would just shiver and freeze. I struggled with my weight; I had been going through this for so long that I just thought that I was a cold-natured person who just needed more sleep than everybody else. I started to become irritable, and I would be shrieking at my kids over stupid little things. Then I felt so guilty because that’s not the mom that I wanted to be. My poor husband bore the brunt of my Wicked Witch of the West impersonation, and he would call me from the car on his way home to hear the tone of my voice because that gave him a warning.

Was it safe to come home, or did he need to suit up with some armor before he stepped in the door? I wasn’t always on my best behavior. It was so confusing to me because nothing in my medical training helped me understand what was going on, and what finally changed everything was that I read a book that was written by Suzanne Somers. Chrissy Snow from Three’s Company. Now, I know that as doctors, we do not want to get our medical information from celebrities and Chrissy Snow, like you remember the ThighMaster.

Jennifer Simmons, MD

Oh, yes, I owned the ThighMaster.

Deb Matthew, MD

A lot of us did. But I read the book because I didn’t know what else to do. When I read the book, I read all the stories of these women, and they felt bad just like me. Then I read about how much better they felt when they got the hormones and balance. It allowed me to open my mind. I learned what was wrong because I had Hashimoto’s, which is an autoimmune condition that causes hypothyroidism. I had been on thyroid replacement medication at this point already for ten years. Now it took ten years for me to even get diagnosed, but for ten years I’d been on the medicine, and my lab tests were normal, but the medicine wasn’t making me feel normal. So medical doctors will just tell you if your lab test is normal, that it’s your age, maybe you’re depressed, maybe you should get your lazy butt off the couch and go exercise, and that’s why you can’t lose weight. But all of a sudden, I realize there’s more going on with my hormones.

Jennifer Simmons, MD

So it’s not me. It’s you.

Deb Matthew, MD

Yes. Once I understood well and could get things back into balance, I got my energy back. My kids got their mom back, my husband got his wife back, and I got my life back. But I couldn’t go back to being the old doctor. I just wrote prescriptions all day long because it didn’t make any sense to me anymore. I completely retired and retrained. So now, for the last 16 years, I’ve been helping men and women get their hormones back in balance so that they can get well, get off a lot of those prescription drugs, and love the way they feel.

Jennifer Simmons, MD

That is amazing. I’m sure for the thousands of women that you helped do that, that’s life-changing. Like you, they probably got their lives back. Now, I do want to go into it a little bit because you use the term hormone balance and I use the term hormone balance, but what does that even mean?

Deb Matthew, MD

That is such an important question, because if anybody listening today goes and marches into their doctor’s office to say, My hormones are out of f balance, That’s not terminology that a lot of doctors use or believe in. So if you march in the door and you talk about me, the number one thing that women complain to me about when they come in is that I just don’t feel like myself. Like, this isn’t me. I don’t feel normal. But if you go to your doctor and you say, I don’t feel like myself; I don’t feel normal, this isn’t me. That’s just got Prozac written all over it.

Jennifer Simmons, MD

That’s exactly right. That SSRI is being written right for you.

Deb Matthew, MD

Yes. Or you say I don’t sleep, I can’t lose weight, or I’m bloated. They’re all nonspecific symptoms. There could be lots of things that are causing these symptoms. What happens to so many women is that they are told it’s your age. This is just that time in your life, or it’s just menopause, and you just get through it, or they’ll say it’s normal, or sometimes women will say, like, could you measure my hormones? Like, could I get tested? They’re told, No, we don’t do that. Or you’re too young to have a hormone problem; a lot of it gets dismissed. So there are so many women out there who are feeling like they are not being heard. Nobody is listening. They are not being taken seriously. It is so frustrating. If you trusted your doctor and walked into the doctor’s office, you were looking for hope, answers, and solutions. What you got was either the prescription or everything being normal.

Then you lose hope, and then what are you left with? Like, is this what’s going to be for me? But the reality is that our hormones are important. They are chemical messengers. That means they float through our bloodstream, and they tell parts of our body what to do. If you don’t have the right amount of hormones in the right balance, then the instruction is that your body gets out of kilter. These hormones are so important for who we are on the inside, how we relate to the world around us, and how we react to other people. I have a theory that is completely unscientific and unproven, but we have all these Karens out there who are saying silly things and getting themselves into trouble and misbehaving. If you look, it’s mostly women in their forties and fifties.

They just need to get the hormones back in balance so they can zip their lips and not say those silly things and do those silly things that they shouldn’t be doing. But hormones are so important, and when we are in our forties, our hormones are starting to change. We call that perimenopause that time in our lives, and it’s like puberty in reverse. that when you go through puberty, we know that hormones are changing and moody teenagers and all of that. But it’s the same thing, just going backward as our ovaries are cutting down and our hormone levels are declining, and it doesn’t always feel good. We can get more irritable and anxious, and we don’t sleep soundly.

We can get night sweats, and we can start to have trouble with our weight. All of these things are hormonal, but you may have no idea that they’re connected to your hormones. If your periods are getting messed up and they’re getting either heavier or irregular, you probably have a clue that there’s something hormonal there. But if you’re just ready to, like, bop your husband over the head because he’s breathing too loud, you may not realize that the hormones are playing at all.

Jennifer Simmons, MD

I agree. What I want to bring up is the thing that most people aren’t thinking about. That’s the average age of menopause in this country is 52, which means that some people are going to go through menopause at 42. Some people are going to go through menopause at age 62. menopause, that perimenopausal period is about ten years. If you’re someone who’s going to go through menopause at 42, that means you’re in your thirties with perimenopausal symptoms. But the problem is that your doctor is not going to recognize it. That’s why they’re apt to prescribe you a sleeping pill because you can’t sleep at night, an anxiety pill because you’re anxious, or an SSRI, an antidepressant, because you’re depressed or tired, or do what I’m saying? So there’s just not enough recognition of this process.

Deb Matthew, MD

Yes, we’re not taught this at medical school. What we are trained in is how to treat diseases with drugs or with surgeries. This isn’t a disease, first of all. That makes it hard because you’re not exactly sick, but you don’t feel good, and there’s no prescription drug for this. We’ve got hormones, and we can talk about that. But with the anti-depressant, the sleeping pill, etc., they’re putting a Band-Aid over your symptoms. Maybe they do make you feel a little bit better, but they’re not going to get you all the way well because they’re not fixing the root of the problem. But you may have been the one to say, I don’t know. Someone that I was talking to said, I feel like I should ask for a partial refund from medical school because they left out a whole bunch of important stuff that we need to know.

Jennifer Simmons, MD

It wasn’t me who said it, but I wish I had. They do leave a whole lot of stuff out. In saying that your hormones are balanced, what you mean is that you feel like yourself. You have the energy of the patients, the tolerance, and the joy. You can sleep, you’re able to move, you’re not achy, and you’re not this way that you’re able to maintain your weight ever so effortlessly. That’s what you mean by hormone balance?

Deb Matthew, MD

Yes. Just feel great. You feel healthy.

Jennifer Simmons, MD

Is this possible in the state that you’re describing? Is this possible in the postmenopausal population?

Deb Matthew, MD

It is possible. Now, there are a whole bunch of factors that go into what happens with your hormones when you go through menopause. But estrogen and progesterone go down because they’re made in your ovaries, and your ovaries stop working when you go through menopause. Estrogen is important for your heart, your brain, and your bones. When estrogen goes down, we can’t remember why we walked in the room in that word. That’s right on the tip of our tongue. We get the vaginal dryness, and we are more prone to osteoporosis, hip fractures, heart disease, and things like that as time goes on. Estrogen also keeps moisture in our body, so we get more dry eyes, dry skin, etc. Progesterone is a calming hormone, so it helps us sleep soundly through the night so we can feel refreshed the next morning.

It helps us feel calm and cool, as opposed to irritated, impatient, critical, and negative. They know this is me with my suit of armor on or my husband meeting his suit of armor on progesterone. It helps a lot with anxiety. For me, I was waking up in the middle of the night with anxiety attacks for no apparent reason. Nothing was going on, but it was because my progesterone was going down at that point in my life. Another one to talk about for just a moment here is testosterone. We think about that for men. But women need testosterone, too. This one is motivating. It is your job to get up and go and get things done. It’s your self-esteem, your decisiveness, and your confidence. So when testosterone goes down, a lot of women just feel flat and blank. You put one foot in front of the other and make your way through the day. If there’s something that has to get done, you’ll find the strength to make it happen.

But if it doesn’t have to happen today, you just push it to the side and procrastinate. All of these things impact how you feel, how you behave, how successful you are in your career, and how you show up to your family. When they change, they do so too. It’s different for everyone. We don’t have every one of these symptoms; they are all very unique. Some factors impact how these hormonal changes affect you. One important one to talk about is stress. When we have more stress in our lives, it makes cortisol go up. That’s our stress hormone. Cortisol regulates all the other hormones. So when you have a problem with cortisol because of chronic stress, you will likely have a bumpier ride through menopause and more hormone imbalance.

If we can help calm the stress, then we can help to even out hormonal symptoms to some degree. There’s a study that took women who were menopausal and had hot flashes, sent them to the spa for a week, measured their cortisol level, and saw that it was high at the beginning of the week and got less at the end of the week, and their hot flashes got less by the end of the week. Blue Cross Blue Shield should pay for all of us to go spend a week at the spa if we’re having problems with menopausal symptoms. They’re not coming back, in my opinion, but that’s what I would say.

Jennifer Simmons, MD

That’s brilliant advice.

Deb Matthew, MD

Managing stress is one of the ways that we can help improve hormonal balance after menopause. Other lifestyle factors help to improve, like eating a healthy diet, getting the vitamins and minerals that your body needs to be able to make some of these hormones move your body, physical exercise, and getting enough sleep. Leading a healthy lifestyle is very important for having balanced hormones at all ages. But the reality is, that once we go through menopause and our ovaries stop making estrogen, progesterone, and testosterone, we are only able to make very tiny amounts of these hormones in other parts of our body. The hormone levels are going to go down, and they’re going to stay down unless we use hormone replacement therapy. There are herbs and other natural things that can help minimize the symptoms of menopause, so they can dampen the hot flashes, but they’re not giving all of the true benefits of the hormones on your brain, on your skin, on your heart, on your bones, etc.

Jennifer Simmons, MD

Can we talk about what those side effects are? Because for some people, they’re very real. Once you go through menopause, there is a rapid deterioration in the health of a number of your organ systems. Can you touch on that a little bit?

Deb Matthew, MD

Yes. that is the first five to 10 years after menopause, so once your periods stop, the next five to 10 years are a time in our lives that is very inflammatory. We get even more inflammation in our bodies, and the aging process is accelerated. A lot of negative changes are happening in that time frame, right after menopause.

Jennifer Simmons, MD

Is that because our hormones, estrogen and progesterone, testosterone, are anti-inflammatory?

Deb Matthew, MD

They are, especially since all of them have positive benefits. Estrogen is an antioxidant. It’s anti-inflammatory. It helps to keep tissues elastic, resulting in fewer wrinkles because our skin stays elastic, but also because our blood vessels are more elastic. When you lose estrogen, you get more hardening of the arteries. You’re more likely to get high blood pressure over time, and that impacts heart health. and progesterone also has a lot of great benefits. It is a neurosteroid, which means it’s a hormone that helps to protect your brain. Testosterone is very anti-inflammatory. Yes, all of these hormones are very important to maintaining health. They also help to stimulate and nurture stem cells, which are our cells of youth and regeneration. So as your hormones drop, a lot of things change. After ten years or so, things level off, and the rate of decline slows. But that first chunk of time right after menopause is an important time in a woman’s life.

Jennifer Simmons, MD

You alluded to this a little bit about endogenous estrogen; our estrogen is anti-inflammatory, as are progesterone and testosterone. However, we have a common perception in the breast cancer world that estrogen causes breast cancer. What do you think that’s all about?

Deb Matthew, MD

Okay. I’m going to take a deep breath before I start. It’s so frustrating, isn’t it?

Jennifer Simmons, MD

 Yes.

Deb Matthew, MD

We’re going to bust this myth. Estrogen does not cause breast cancer. Radiation can cause.

Jennifer Simmons, MD

Frenzy or heresy.

Deb Matthew, MD

Radiation can cause breast cancer. Toxins in the environment can cause chemical changes that trigger breast cancer. Other cancers can be caused by viruses, but hormones don’t cause cancer. Why do people think this? One of the reasons is that women when they get diagnosed with breast cancer, are told if they’re breast cancer cells, estrogen receptor-positive, or estrogen receptor-negative. Often, it’s described that the cancer cells are estrogen-fed or that they’re not estrogen-fed. The implication is that your estrogen causes your breast cancer. That is not true. What that means is that your cells are closer to normal. It’s a good thing if your cells are estrogen receptor-positive or estrogen-fed. Normal breast cells have estrogen receptors.

They’re supposed to have estrogen receptors. They are supposed to be estrogen-fed. It just means that estrogen nurtures those cells. If you have a cancer cell that is more changed, it looks less and less like the normal cell that it started from. Now it loses the estrogen receptor. That’s a worse prognosis. It’s not that estrogen caused the cancer. It’s telling your doctor whether estrogen, or whether your cells are still closed, are closer to normal or farther from normal. Does that make sense?

Jennifer Simmons, MD

I also think that a part of that is that that’s a very simplistic explanation that people can understand. Like all your cells, they have estrogen receptors on them. We’re going to use that as the target of therapy. All they hear is, estrogen must have caused my cancer if I have cells that have estrogen receptors on them. But, like you said, normal breast cells have estrogen receptors on them and progesterone receptors on them. Interestingly, the reason that we don’t talk about progesterone so much is because no one came up with an anti-progesterone drug. We talk about estrogen a lot because we have synthetic compounds that work on the estrogen receptor. One of the most misunderstood things is Tamoxifen because people think Tamoxifen is an estrogen blocker, but Tamoxifen is a synthetic estrogen. That’s what it is.

Deb Matthew, MD

It just attaches differently and has different effects on the receptors than regular.

Jennifer Simmons, MD

Yes, well, but, for instance, in the breast, it’s non-stimulatory. But you could argue that our endogenous estrogen is not stimulatory. It is doing hormone signaling and balance by progesterone, but it is protective. I want to get to how we know that estrogen is protective. But when you look at Tamoxifen’s effects in other areas of the body, it’s inflammatory. In that, we see an increase in uterine cancer and endometrial cancer among Tamoxifen users. and I don’t know if it’s because it’s synthetic. So it’s having that adverse effect because it doesn’t look just like estrogen; it doesn’t bind it just like estrogen. So, perhaps that is the reason, but it’s so funny that people think, Oh my God, I would never take hormone replacement. I’ve had estrogen receptor-positive breast cancer, and then they go on Tamoxifen well.

Deb Matthew, MD

They’re following their doctor’s advice.

Jennifer Simmons, MD

That’s true. 

Deb Matthew, MD

Many doctors are afraid of estrogen. I work with lots of other practitioners who believe in the benefits of hormones, and they’re learning how to prescribe hormone replacement therapy and bioidentical hormone replacement, which is the natural form. They’re still scared of estrogen-like we are; it has just been beaten into us to be afraid of us. Now, we’re not afraid of prescribing antidepressants and muscle relaxants like we prescribe antibiotics. We prescribe medicines all day, every day. We’re okay with that. But yet, we’re so scared of estrogen. The reason is pretty clear: we weren’t used to being scared of estrogen. When I was in medical school in the nineties, I was taught all women need to go on hormone replacement therapy at menopause because it’s going to protect your heart, your brain, and your bones. It’s like the greatest thing since sliced bread. If we told you you needed to be on hormone replacement therapy and you didn’t take it, we thought you were a bad patient, and the problem was that.

Jennifer Simmons, MD

We would write that in the chart.

Deb Matthew, MD

Non-compliant. But the problem was that we were giving everybody the same dose. We’re all unique. Some women just need a little bit, and some women need a little more. Lots of women had side effects, and it wasn’t the right way to do it. But we weren’t scared of it until 2002 when this big study came out. It’s called the Women’s Health Initiative Trial, and it said that the women on hormone therapy had an increase in the risk for breast cancer. Overnight, it became this huge thing. All the gynecologist’s phones are ringing off the hook, and women are freaking out, and it’s on the news. As doctors, we were horrified because we thought we were helping people, but, oh my gosh, we’re causing breast cancer. It just got seared into our psyche. It has been so difficult to get people to realize the truth. So Peter Attia is a doctor who has a podcast, and he said that, in his opinion, this thing, this scaring women off of hormones, is probably the biggest and most bad mistake that we have made in our lifetime in terms of men and women’s health. So the reality.

Jennifer Simmons, MD

Well, until three years ago.

Deb Matthew, MD

The reality of this hormone myth is that in this study, there were two groups of women. One of the groups of women had a hysterectomy, and the other woman had her uterus. The women who had their uterus got a pill with estrogen and progesterone. The women who had a hysterectomy weren’t given the progesterone part of the combo pill because the thinking at the time was that the progesterone was there to protect your uterus from the effects of estrogen. Well, if you don’t have a uterus, you don’t need it. They just got estrogen. These women who just got estrogen did not have an increase in the risk of breast cancer. They had a slight decrease in the risk of breast cancer. If we look at studies, I even wrote down a quote. I’m going to read you the quote.

It said, In younger women receiving estrogen only, not the combo pill, there is a great consistency between all randomized trials, including the Women’s Health Initiative, one that scared everybody showing coronary benefit. protecting heart disease and a decrease in all-cause mortality and including a decrease in breast cancer in all ages of women who took this, there was no increase in the risk for breast cancer. that is consistent across studies. The problem came with the combo pill. These hormones that we were given are not the natural forms of hormones in a woman’s body. specifically, progesterone, a man-made synthetic chemical that’s never been found on earth before. It was made in a lab. It was that synthetic, man-made chemical that was associated with an increase in the risk of breast cancer.

In the study, there were eight extra cases of breast cancer per 10,000 women. That’s less than 1%. But it was when we compared it to how many women would have gotten breast cancer if they weren’t on hormones, compared with how many women did get it. If they took the hormones, it was counted as a 24% increase because, I don’t know, I can’t do the math in my head. It was like 30 women who weren’t on hormones versus 38 women per 10,000 who were on hormones. So the difference there comes out to 24%, or, I don’t know, don’t double my math. But yes, when it says 24% increase in the risk for breast cancer, it sounds like 24% of women are getting breast cancer themselves, supposedly like flies.

Know that in reality, your chance of getting it is like a 99.9% chance of not having breast cancer when you’re on it. It sounds very different, and it wasn’t statistically significant, meaning it might have just been a chance that if you throw the dice enough times, you can get some numbers that are a little skewed. It was a very tiny thing, but it caused such an enormous response and an enormous fear that it scared an entire generation of women, including hormones. Now those women have osteoporosis, dementia, and heart disease, and it hurts to have sex, and their skin is all wrinkly, and they don’t feel good. It was so unnecessary. But the fear is just so persistent and could quadruple or ten times more once we talk to women who’ve had breast cancer.

Jennifer Simmons, MD

Yes, absolutely. From my perspective, it’s two generations of women because we still have not recovered from that. Things are changing, but they’re only changing slowly. A lot of those women, because they didn’t go on hormone replacement, died of cardiac disease because that is a major factor in who does it and who does not develop cardiac disease. Yes. We only see the difference between men and women up until menopause, and then when women are in you, you say that there is a rapid deceleration of the health of the blood vessels, the heart, the tissues, and the elasticity of the tissues. The heart depends on having healthy blood vessels and those elastic, muscular walls. If you lose that function and lose cardiac function, this is not a survivable thing. So thousands, if not millions, of women, have died prematurely of heart disease. When we have a solution right there.

Deb Matthew, MD

Yes.

Jennifer Simmons, MD

There wouldn’t. We continue to suffer. Underneath this fallacy.

Deb Matthew, MD

There was a study that was done back in 2011. This is more than ten years ago now, but about ten years after that study and what they concluded, they crunched the numbers and predicted that about 90,000 extra women died because they stopped their hormone replacement therapy. It’s got me very upset.

Jennifer Simmons, MD

Understandably so.

Deb Matthew, MD

I still see women coming in, and they’re coming to me and saying, My hormones are out of whack; I don’t feel good. I feel like I want to try some hormone replacement therapy. My doctor says, No, they’re warning me often, or they’ve been on hormones. Their doctor says you have to come off of them. Now, look, this isn’t just for the public. This is the medical community that is still there. There are lots of doctors who are good with hormones because even the North American Menopause Society, like the Academy of Obstetrics and Gynecology, agrees that hormones work and hormone replacement therapy works great for hot flashes. It works great for vaginal dryness and urinary symptoms. It’s good for bone health that for the majority of women, especially if they’re within ten years of menopause, the benefits far outweigh the risks the tide has turned, and even the powers that be recognize the important benefits of hormones. It’s just so hard to get that through because everybody got so ingrained.

Jennifer Simmons, MD

Yes, let’s talk about who needs hormone replacement.

Deb Matthew, MD

Women who are over the age of 35 may start to have changes, especially in their forties, such as lower progesterone and lower testosterone, and sometimes they don’t feel good. So if that’s where you are, if you are in your late thirties and your forties, and especially if you have heavy periods—periods that are coming more frequently, more PMS—you’re not sleeping at night; you’re having night sweats. If you have cyclic changes like your good one week of the month and then it goes downhill, and then you start to feel better when you’re on your period again, If you’ve got those changes, that’s a hormonal thing. Balancing out your hormones by replacing progesterone and testosterone can make a big difference for anybody at any age.

If cortisol is out of whack, it regulates your other hormones, so it messes up your other hormones. All of us should be trying to deal with stress healthily life. For women who are part of the approximate average age of menopause, which is about 5152. Somewhere in that ballpark are estrogen drops. Once the estrogen drops, the symptoms change a little bit more. The hot flushes are annoying. But to be honest, if hot flushes were the only thing that we had to deal with, we would put up with it. It’s not the greatest thing. But we would make do because our brains don’t work like you can’t remember why you walked in the room or where you left the car keys, and you have to put sticky notes everywhere you go to write everything down so you can remember it. We get sometimes more tired, more depressed, or we can’t focus, and we’re not as creative. Like, we just don’t feel right. Sex can be painful. We can start to leak urine. All these things go on, and a lot of them aren’t measurable. Like, we can measure how many people have a heart attack, and we can measure who and what your blood pressure is. But we can’t measure things like the quality of your marriage, whether you can’t get along with people, whether you’re able to enjoy intimacy, whether you’re thriving in your career, or whether you’re hiding in your office on the computer, hoping nobody’s going to notice that you’re not being very productive because you just can’t think straight and just don’t feel like it.

Jennifer Simmons, MD

Let’s talk about the people who don’t have symptoms that they can quantify. I have plenty of people who say to me, like, I feel fine; I’m fine. I’m not having problems with sex, and I’m not having problems with sleep. I’m not having hot flashes. What about them? Is there a benefit to hormone replacement for people who are seemingly saying it?

Deb Matthew, MD

It means that there is because there’s sometimes a honeymoon period. Some people have a bumpy ride when they go through menopause; they get lots of hot flashes, and then sometimes the hot flashes die off and they’re okay. But eventually,  being without hormones is going to increase your risk for heart disease, dementia, osteoporosis, wrinkles, painful sex, etc.; it creeps up on you, and you get the best results if you start early. It can be prevented going forward. That’s where it works the best. If you wait until you’re 70 and then you decide, Oh, well, now I want to start the hormones. We can’t go back and erase all of the aging that happened over the last 20 years. In my opinion, there are so many benefits to the hormones that even if you don’t feel terrible, I still feel that the benefits of the hormones to keep you feeling well over time are well worth it.

Jennifer Simmons, MD

This ends up being a controversial topic in the breast cancer population because what happens with most breast cancer patients is that they have hormone-positive disease. After all, it is the disease that most closely resembles normal tissue. By the time we talked about this a little bit before, like for those that are triple negative, that is a far departure from the normal cells. so that is going to be a more aggressive process. The more it looks like normal tissue, the less aggressive the process is; the more it departs from normal tissue, the more aggressive the process. The vast majority of women are going to have hormone-positive diseases. Because they have estrogen receptors, they’re there. They’re told that their estrogen is bad. Estrogen is bad. We had to get rid of the estrogen. So there they’re made post-menopausal, either themselves or drugs.

Deb Matthew, MD

Or have hormones right now.

Jennifer Simmons, MD

Should never, ever have hormones. So they are in quite a spot, and especially if we’re talking about a woman in her forties and we’re going to make her menopausal, the truth is that the vast majority of women are going to survive their breast cancer. We are condemning them to a quality of life that is less than and a shorter life as a result. Because if we’re going to give them heart disease because we’re taking away their estrogen, then that is a far bigger problem. What about the postmenopausal breast cancer population or the premenopausal breast cancer population that is rendered menopausal by the treatment?

Deb Matthew, MD

It’s hard because no matter what I believe to be true, no matter what I see written in the medical literature, my medical board is going to agree with all of those doctors who say you should never have hormones. It’s very difficult for doctors to give women who’ve had a history of breast cancer hormone replacement therapy. But the studies don’t support that. Giving women hormone replacement therapy after breast cancer increases their rate of recurrence or death from their breast cancer. The opposite is ever-looming: an oncologist who has written a whole book about what the studies say about hormone replacement therapy and breast cancer. When women have active breast cancer, that’s one scenario where that’s probably not the best time. But once they’ve been past breast cancer for about five years, that’s the line that most doctors who are willing to even entertain this would use as a time to think about offering the option of hormone therapy. Most doctors are okay now with using vaginal hormone therapy, so there’s no need to have the vaginal dryness, the painful sex, or the leaking urine. That’s something that can be helpful. Testosterone can be helpful because most doctors are afraid of estrogens specifically. But testosterone has lots.

Jennifer Simmons, MD

In there, they’re unaware that testosterone gets personalized, intense estrogen.

Deb Matthew, MD

But estrogen can help keep your muscles and your bones strong. It’s energizing. It motivates. It makes women feel a lot better. So even if someone’s going to choose to stay away from estrogen and progesterone or your doctor is not willing to go there, testosterone is not a bad option. What I do is have women go back to their oncology just to let them know we’re thinking of giving them some testosterone. I’m finding more and more that the oncologists are saying that that’s okay. No, you’re right. They probably don’t realize that the testosterone keeps going to a little bit of estrogen. Nonetheless, we can have it, and it makes a difference.

Jennifer Simmons, MD

And as you said, everyone needs to know that there is no reason to not have vaginal estrogen in that studies have shown that you do not get significant systemic levels. so there’s no reason to suffer through that part. That part is hard. I often hear people discount that. But guess what? Like, if you are having painful sex, you don’t want to have painful sex. You don’t want to have burning when you urinate, you don’t want to have leaking when you urinate, and you don’t want to have thinning of the vaginal walls.

Deb Matthew, MD

You don’t want to be underpinned, right?  

Jennifer Simmons, MD

It’s hard to stay in a relationship if you despise intimacy. That is one surefire way to despise intimacy. It should be offered across the board to everyone who has had her breast cancer treated or is postmenopausal because there’s no reason to suffer that way.

Deb Matthew, MD

Just quickly, some of the other things that we can do to help with that besides moans because there are some over-the-counter creams like Julva, which is one example, is a cream that has some DHEA and some other natural things in it that can help with vaginal dryness. That’s one option. But there are also vaginal laser rejuvenation procedures, such as PRP, which is platelet-rich plasma, where we draw your blood and use your growth factors to help regenerate tissues. This is part of regenerative medicine, which is the future of medicine. These are new hormonal treatments. Well, the Julva has a stoma.

But the vaginal lasers and the PRP are non-hormonal treatments that can make a big difference. Whether you’re going to choose hormones or not, you do not have to suffer from painful sex and leaking urine because we can even do sound wave therapy. Some things are available. It’s just that they’re not covered by health insurance. Your regular doctor is unlikely to have these available, but they are out there. You do not have to put up with it.

Jennifer Simmons, MD

Yes, I agree. The book that you were referring to is Estrogen Matters by Avrum Bluming and Carol Tavris. That is an important book for any woman to read, but especially for women going through breast cancer. What’s so interesting is that Avrum Blumin is a medical oncologist or a surgical oncologist who specialized in breast cancer for his entire career, when his wife got breast cancer, she said, What am I going to do? Am I going to go on hormone replacement? Then afterward, he said, You’ve been listening to me talk for years and years. The decision is yours. She went on, and it’s interesting to note, certainly from the Women’s Health Initiative and from the other studies that we see, that women who are on hormone replacement are going to get breast cancer, just like women who are not on hormone replacement were going to get breast cancer because there are other environmental mental factors in play, and it is not solely built around who is and who’s not on hormone replacement, but the women who are on hormone replacement and get breast cancer prognostic lead do better.

Deb Matthew, MD

Likely to die.

Jennifer Simmons, MD

Yes. Then the women who aren’t. That is part and parcel of the fact that women on hormone replacement are healthy.

Deb Matthew, MD

Yes, less likely to die either.

Jennifer Simmons, MD

Dr. Deb Matthew, this has been an amazing conversation. We went over so much that I’m just going to try to review a little bit. We talked about what hormone balance means and it means that you feel great, you feel well, and you feel like yourself, and that is something that starts to change for women in their thirties and forties. If that is happening to you, you don’t have to put up with it. We talked about the benefits of estrogen, what estrogen does to progesterone, what progesterone does, and what testosterone does in terms of motivation, getting it on, self-esteem, and confidence. All the while, with all of this, before you would even consider a hormone replacement, you have to effectively manage your stress. You have to work on your lifestyle. Being on a healthy, nourishing diet using vitamins and supplements, but making sure that you’re getting as much as you can, vitamin and mineral wise, from your diet, having exercise or movement, joyous movement in your life, and prioritizing sleep. 

Some herbs can minimize the symptoms of menopause, but the only way to maintain the health of your heart, your brain, your bones, and your skin is to go on hormone replacement because that is the only thing that is going to continue to protect those organs. In our talk, we definitively said that estrogen does not cause breast cancer. You and I will say it again and again and again and again until everyone has heard it. that breast cancer is an environmental disease caused by radiation, toxins, viruses, and all of these other things that surround us. But it’s not the estrogen that is being made in your body that is causing breast cancer. That is a fictional, simplistic explanation. I didn’t know about the 90,000 extra women dying as a result of not having hormone replacement.

Deb Matthew, MD

Well, that was it.

Jennifer Simmons, MD

That’s a scary statistic. I hope that the medical establishment reads that all of the findings of that study have been retracted. I hope that they read that retraction. I hope that they start to understand and change their practice paradigms because women should not suffer because of the fear that was created 20 years ago. That was just false. There are some methods that you can use to help with vaginal health. But at the end of the day, the only thing that is going to protect all the organs that we talked about is hormone replacement. If you are someone who has had breast cancer or is in remission, you have done all of those things. Dr. Deb talked about working with your diet, managing stress, exercising, sleeping, and having no evidence of disease. After five years, it is perfectly appropriate for you to be on hormone replacement. Did I miss anything?

Deb Matthew, MD

That’s great.  The message that I would love to make sure that everybody hears is that if you’re not feeling your best, your doctor doesn’t have a pill to fix you. It’s not a Prozac deficiency or an Ambien deficiency; it could be a hormone imbalance. There’s so much in your power to make it better, and living well is the best medicine.

Jennifer Simmons, MD

Dr. Deb Matthew, where can people find you?

Deb Matthew, MD

The office website is signaturewellness.org, and there’s lots of information on the website. I have a book that you guys are going to offer to give away.

Jennifer Simmons, MD

Yes, that will be wonderful. What’s the title of the book?

Deb Matthew, MD

This Is Not Normal is a Busy Women’s Guide to Symptoms of Hormone Imbalance, and it has a lot of checklists to figure out. Could your symptoms be from a hormone imbalance? It also has some resource guides. First of all, what can you do to help yourself get better? But also, how can you find a doctor who can help you?

Jennifer Simmons, MD

Wonderful. Dr. Deb Matthew, it was such a pleasure to talk to you today, as always. I hope that your message, which is so well articulated, is heard by our fellow physicians so that practice can change and women can stop suffering because it’s so important to give people the right tools to feel the way that everyone deserves to feel. It’s Dr. Jenn.