Science is a process

I was a medical student at the turn of the century (No- not THAT century! I’m not that old!). And during that time, attending physicians told me over and over that hormone replacement therapy was a must. I remember one female doctor going as far as to say that it was malpractice to not put a (peri)menopausal women on estrogen. That was medical school. And then 2002 came and BAM!!!! In the blink of an eye, EVERYTHING CHANGED. The Woman’s Health Initiative (WHI) study was paused, and hormone therapy came to a halt for all intents and purposes. 

I was in my first week of residency when the study was released, and it was overwhelming as a new doctor to get calls from patients (many of whom I had yet to meet) asking what they should do about their estrogen. At the time, the study was stopped midway because women who had been on estrogen and progestin for approximately 5 years were found to have increased risks of breast cancer and heart disease. Due to the perceived risk, everyone came off their hormone replacement and all a sudden I was telling women to wear lightweight clothing, use air conditioning and take an antidepressant to try to help with sleep, heat intolerance and mood changes.

Fast forward to now, and as a 49-year-old woman, I can’t believe those patients didn’t punch me in the face. I was 25 years old and telling them to deal with it.  Around the time I turned 45, I noticed things in my body shifting. I was walking down the stairs more gingerly. There was an ache in my fingers in the morning. The itching! Oh my gosh- the itching! I had itching in my armpits and around my nipples (TMI, I know). The insomnia. My periods looked like remnants of a crime scene. My thick lustrous hair was coarse and frizzy. My mood changes were inconsistent and when I tried to find a pattern, there was none to be found. And of course, I was a little slower at the brain teaser puzzles that I was doing in the morning. Hello PERIMENOPAUSE! What if a doctor had told me to deal with it?  Spoiler alert: they did….and I did not punch them! Instead, I decided to get certified in menopause care and help other women in my same situation.

Did I mention my hair was getting grayer by the moment?

Thankfully, twenty years have passed since July 2002. While there were some arms of the study that were halted early, there were others that continued, new studies that were started, and older data that was relooked at and picked apart. Science is not static. And YOU should not want it to be. Scientists should be everlastingly curious- reviewing old data and repeating experiments and testing new therapies. Scientific discovery should never stop, even when you think you have the answer. And changes that stem from good scientific research should not be penalized but rather celebrated and built upon. New data since the 2002 study shows a window in the perimenopausal period where estrogen is BENEFICIAL. Decreased hot flashes, decreased risk of heart disease, decreased risk of osteoporosis just to name a few. We just had to get the timing correct. Yes, oral estrogen did increase the risk of stroke and heart attack in older women who were post-menopausal but in other women it did the opposite and that is why I dedicate a part of my practice to menopause care. We need to educate women (patients and health practitioners).

Also, I started an estrogen patch. And guess what- my itching stopped, and my fingers stopped aching. The brain fog is still there but it is not getting worse. Now, estrogen may not be right for everyone. Every body is different.  But what this experience did teach me is that there are many women that medicine has failed, and we should all be working to correct that. Every woman deserves to not feel like shit and while the decision of what to do is up to her, she should be presented all of her choices and empowered to do what is best for her.

No- I don't look like this now. But there are days where I feel like this :)