828: Bioidentical Hormone Replacement & Navigating Menopause After Breast Cancer With Dr. Jenn Simmons

Child: Welcome to my Mommy’s podcast.

Hello and welcome to the Wellness Mama podcast. I’m Katie from wellnessmama.com and I’m back today for round two with Dr. Jenn Simmons for another amazing episode. If you missed our first one, I feel like it is a must-listen. She really delves into the data and the research and the statistics on screening for breast cancer and how this can often do more harm than good. And I’m so excited to have her back for this episode where we get to go even deeper in some related topics, including bioidentical hormone replacement, and navigating menopause after breast cancer. Though truly the way she explains this topic, it can apply to women of any age. And she shares how she was trained and went from thinking that hormone replacement was a terrible idea and that she would never do it to this being a foundational part of her own health journey and now her approach with patients as well. Like I said, if you missed our first episode, I highly recommend listening to it. If you have or will be screened for breast cancer at any point, I love the new technology that she’s brought to market that is FDA-approved and absolutely groundbreaking. And in this episode, we talk about the nuance of hormone replacement, how we need certain levels of certain hormones for things far beyond just what we consider the realm of hormone health and how this impacts our bone health, our heart health, our brain health, and so many other things that come into play as we get older. And she tackles head-on the widespread narrative of the link of hormone replacement to cancer and what the data actually says, what we need to know now. And as we step into the driver’s seat of being our own primary healthcare providers, how we can navigate this with the most grace, ease, and joy. I absolutely love Dr. Jenn. She is so well-researched, so well-spoken, and I think you will learn a tremendous amount from this episode. So let’s join her now. Dr. Jenn, welcome back.

Dr. Jenn: Thank you. Thank you. It’s so nice to see you again.

Katie: Likewise, and if you guys missed it, our first episode together, Dr. Jenn was absolutely phenomenal explaining the downfalls of our current screening methods for breast cancer and some really exciting developments in much better solutions. And in this one, I know you have such wide-ranging expertise, and I would love to go a little bit more nuanced and talk about navigating menopause, and especially after a breast cancer diagnosis, because I feel like there is so much conflicting information floating around related to this, certainly so much fear floating around related to this. I know women hear things like, you should never do hormone replacement therapy because of the risk of breast cancer, or if you’ve had breast cancer, you are never, never going to do that. And there’s so much information around that. So maybe start us off broad and kind of give us an introduction to what’s going on related to if someone’s had breast cancer or is at risk for breast cancer and is going through menopause.

Dr. Jenn: Yeah, absolutely. So I’m going to share from very, very, very personal experience because I come from a breast cancer family. I mean, there’s a reason why I spent my life as a breast cancer doctor in the last 25 years of my life, dedicated to helping women recover from their breast cancer diagnosis and live the life that they want and desire and deserve. So having come from a breast cancer family where the majority of the women in my family both got and died from breast cancer, and then I finished my fellowship training in 2003. So both my history and my training taught me that hormones cause breast cancer. And the gentleman who trained me in fellowship was a world-famous breast cancer doctor. His name was Gordon Schwartz.

And in 2003, when the Women’s Health Initiative was released, the results were prematurely released in the media, stopped the presses. He taught me three things that year. He taught me that hormones cause breast cancer, that the only person that should go on hormone replacement, not even just speaking about the breast cancer population, but speaking about women in general, the only women that should ever use hormone replacement are the ones that absolutely positively can’t live without it. And if you put someone on hormone replacement, it should be the least amount for the least amount of time and get them off as soon as you could. Okay. So this is the ideology and the dogma that I both grew up with and did my training with, right?

So here I am. I go out into the world with my big girl pants and I’m a big girl doctor. And for nearly 20 years, this is the dogma that I practiced under. I believed that hormones cause breast cancer. I believed that hormone replacement was unnecessary and that I was in no uncertain terms never to be a candidate for hormone replacement because I come from a breast cancer family. And the only thing that I was certain of my entire career was that I would eventually get my own diagnosis. So there was no way that I could use hormone replacement.

So I’m going to fast forward to, I’m in my late 40s, and I start getting dizzy spells. I think I’m having a stroke. I go have a brain MRI. Nothing, they see nothing, everything’s fine. It’s just you. I’m starting to have palpitations. I think I’m having a heart attack. I go to the cardiologist to have a huge cardiac workup. Nothing, your heart’s fine, you must be nervous. I’m not a nervous person. I don’t have anxiety. Well, it’s you. It must be in your head. I can’t sleep at night. My eyes are like this. I’m exhausted to my core. Exhausted. I mean, I’m running a cancer program, I’m a full-time surgeon, a full-time mom, a stepmom, an athlete, a philanthropist. I’m like, and I’m exhausted at the end of the day. And I’m in bed with my eyes wide open, can’t sleep. Have a sleep workup. You’re fine. It’s just, these things just happen. You must be anxious. You must be stressed. I’m like, but I’m doing the same thing I’ve been doing for however many years.

And then time goes by and I’m so testy with my family. I have mood swings, things that I never had my whole life. Never, ever, ever, ever. And then I had frequent urinary tract infection out of nowhere. Out of nowhere. Painful sex. No libido. And I was like, you know what? I think this is menopause. I think this is menopause. I would walk into a room and have no idea why I came in there. Just something that I thought to go get five seconds ago, walk into the room, have no idea why. I was losing, I thought I was losing my mind.

And so I called a friend who was an integrative doctor and she said, Jenn, you need hormones. I said, I can’t take hormones. I’m from a breast cancer family. She’s like, Jenn, read Estrogen Matters. So there’s this book by Avrum Bluming and Carol Tavris. And I read the book. And I say this all the time, Dr. Bluming saved my life. Saved my marriage. Saved my patients’ lives. Because we never consider the impact that treating people for breast cancer is going to have. So all of those things that I talked to you about, the dizzy spells, the palpitations, the insomnia, the chest pain, the digestive problems, the bloating, the weight gain, the tire around your middle, the yeast infections, bladder infections, frequent urinary tract infections, loss of libido, mood swings, lashing out, brain fog, memory recall, word recall, loss of libido, all of these things, this is menopause.

Now, when that Women’s Health Initiative study happened, this study’s investigators, the primary investigators were after two things. They were after learning whether or not heart disease could be prevented by giving women hormone replacement. And they were after ending the gravy train of hormone replacement. Because they said that it had gone on for too long and it was time to end that gravy train. And they wanted to end it for the purposes of introducing the seven or ten other drugs into people’s routines that you then have to take when you no longer have hormones.

So when you don’t have hormones and your brain doesn’t work anymore, you get depressed, you get anxious, great. We have SSRIs for that. When you don’t have estrogen and you start to have palpitations, great. We have beta blockers for that. When you don’t have estrogen and your cholesterol skyrockets, great. We have statins for that. When you don’t have estrogen and your bones start to go away and you have osteoporosis, perfect. We have bisphosphonates for that. I can go on all day, right? There’s seven, 10 medications that replaced hormone replacement. Seven to 10, and they were happy to use them because they didn’t work that well. And so you went from one to the next, to the next, to the next. It kept you in a doctor’s office. It kept you tied to the pharmaceutical companies. You are, they created lots and lots of patients out of it.

Now, I think that doctors did what they could do. There was, they believed the data. They had no reason to think that they were being lied to. And despite the fact that all of that information was retracted 17 years later, the Women’s Health Initiative was retracted 17 years later. They said that those findings, which they knew then weren’t statistically significant, and there’s so many problems. I could do a whole TED Talk on the problems with the Women’s Health Initiative. But just suffice to say that when they said that hormones cause breast cancer, it simply was not true. And just to think about it logically, if estrogen caused breast cancer, that would mean that God put every woman on this earth for the purposes of getting breast cancer. It’s ridiculous. It’s a ridiculous notion.

Estrogen is a hormone of life. It does not cause breast cancer any more than thyroid hormone causes breast cancer, or serotonin causes breast cancer, or any of the vital hormones that circulate in our body. It simply does not cause breast cancer. And if it did, we would see it during the times when estrogen is the most abundant. We would see it in teenagers. We would see it in young ladies. We would see it in pregnant women. But we don’t. We don’t because estrogen does not cause breast cancer. And when you don’t have estrogen, your body significantly starts to deteriorate. And we know that in the first 10 years of menopause, that’s when we see the most deterioration. And this is the point that it’s so important to get women on hormone replacement.

So let’s specifically talk about the breast cancer population, because that’s the question you asked. When we look at the data that’s out there, all the studies say the same thing. Hormone replacement does not cause breast cancer. And interestingly enough, the women that are on hormone replacement and get breast cancer, because quite frankly, women get breast cancer whether or not they’re on hormone replacement, right? I mean, when you look at the data of breast cancer incidents and you look starting in 1999 and you look out till 2020, we won’t talk about why there aren’t the same amount of diagnosis in 2020. We all know why. No one went to go get mammograms. So people miraculously didn’t have cancer that year. But when we look from 1999 to 2020, we see a steady increase. In fact, it increases a lot starting in 2012 because that’s when we introduced digital breast tomosynthesis or 3D mammogram onto the scene, so we got a lot more breast cancers from that. But in 2003, the drop-off of women who, 40% of postmenopausal women were on hormone replacement before then. And the drop-off went down to like 3% or 7%, something like that. But we didn’t see a drop-off in breast cancers. All we saw was an increase. So hormone replacement does not cause breast cancer. And when we see, when we look at the women who are on hormone replacement and get breast cancer, they actually have better outcomes than the women that get breast cancer and are not on hormone replacement.

And we see the same thing afterwards. For women who had breast cancer, get treated, and go on hormone replacement afterwards, they do not have an increased risk of recurrence, and they have better outcomes. And the reason they have better outcomes is this. Women on hormone replacement don’t have the brain deterioration, so they don’t get as much dementia and they don’t get as much Alzheimer’s. They don’t have the cardiac deterioration, so they don’t have as much heart disease and they don’t have as much cardiomyopathy. They don’t get the bone deterioration, so they don’t have as much osteoporosis. And these facts that I talk about are important. The same exact number of women die of a complication of a fracture every year as do of breast cancer. We need to protect people’s bones.

The same exact number of women, or actually two to three times the number of women, die of heart disease every year, as die of breast cancer. In every generation past the age of 30, women die exponentially more of heart disease than breast cancer. So if you’re going to give a woman hormone blockade after breast cancer and not hormone support, you’re going to double or triple her risk, which is already exponentially more. You’re going to double or triple her risk of dying of breast cancer, of dying of heart disease. So these women who get treated for breast cancer and are called cured then go on to die of heart disease and their death is not attributed to breast cancer because they died of heart disease. And nowhere are we talking about the fact that that heart disease is called Iatrogenic. It is caused by treatment of their breast cancer. And it’s caused because we deplete them of estrogen, or we block their estrogen from being able to work using hormone-blockading drugs, hormone blocking drugs.

So we as a population need to unlearn what we think we know about hormone replacement and relearn the true benefits of proper treatment. So I think we need to be having conversations about hormone replacement for women in their 30s. Perimenopause is a 10-year process. And we ought to be replacing it early and often. Because this is the key to longevity. This is the key to long-term health. This is the key to maintaining brain health, bone health, heart health, gut health. But it’s also the key to maintaining breast health. Because if those other things aren’t working, you’re just going to build up more and more toxins in your breast. I say this all the time. Breast health is health. And the same things that are going to give you a healthy brain, healthy bones, a healthy heart, healthy skin, healthy gut, healthy joints, healthy muscles, healthy tissues. This is going to give you healthy breasts. We’re just one system, and we’re one system working in concert with one another. And we need the proper hormone stimulation in order to do that. And to me, that means having estrogen.

Katie: Well, I literally just ordered that book as we were talking because this is so fascinating to me. And I would guess a lot of people listening can resonate with your experience of having symptoms, going to a doctor and being told you’re fine. Or as I heard, that’s normal postpartum. That’s normal for a woman. That’s normal when you have kids. All these things. And then having to go on quite the journey to actually uncover the root of what was going on.

And you also mentioned perimenopause can start for women in their 30s. And this is something that is top of mind for me now, as I’m in my mid-30s, is thinking, looking forward. When do I need to know this? Where are even the good answers now? And if, as we talked about in our first episode, I want to be my own primary healthcare provider and take responsibility and ownership for my health, how do I find a good partner in that or a good resource in learning how to do that when it comes to bioidentical hormones?

Dr. Jenn: Yeah. So there are a number of people who are doing amazing, amazing work out there. There’s a company called My Alloy, A-L-L-O-Y. And they have a virtual practice. I believe it’s in 50 states, but don’t quote me, where you can have a virtual appointment with a menopause-literate OB-GYN, who will test you, who will talk to you, listen to you, hear what’s going on with you, and be able to prescribe what you need because we are all bio-individual, and everyone is going to be at a different stage in this process. And so for women who are perimenopausal, they need to be tested early and often. And adjusted early and often.

And then there’s a woman named Heather Hirsch. She has the Heather Hirsch Collaborative. They are doctors in, I think, nearly 25 states now. So she does primarily perimenopause and menopause care. So people are becoming more and more aware. People are becoming more and more literate. I think that certainly the damage from the Women’s Health Initiative is still alive and well. But as we move forward and as we have a changing of the guard and as the old school people like me either wake up and become aware of the data or retire, and either one is fine, right? Like, get on the bus or get under it, I think things will change. I think the next generation of consumers, at least, they’re not interested in that paternalistic because I said so medicine. They are far more interested in understanding the why and getting to the root cause and partnering with their providers. I think a new day is dawning. I really believe it.

And as you said, the patient is the doctor of the future. No one is ever going to know you better than you know yourself. No one will be a better steward for your health than you will be. And we just all have to remember that the things that drive health are the things that need to be part of our everyday existence. So we all need to be eating a whole food, unprocessed diet, whatever that is for you. I advocate for a plant-based, low-glycemic, grain-free diet because I think that that is the diet that suits most people and is a driver of health. And then we all have to move our bodies because if you don’t move your body, you lose the ability to move your body. We need to prioritize sleep and sleep at night because sleep is where the healing happens. We need to have healthy ways to manage the stressors in the world because there are so many stressors in the world. The stress is abundant and infinite. And what we need to do is develop a skill set so that we don’t allow the stress to affect us.

We need to be aware of how toxic our environment is and avoid as many toxins as we can, have really good detoxification practices. And we need to have really strong social connections because we are social beings. We need to connect to God, universe, some higher power, and we need to live our purpose and live purpose-driven lives. And when we do that, we will be rewarded with health. Will your journey be linear and easy? No, it won’t be because that’s not what this life is about. And for every mountain you climb, the next one is in the horizon for sure. But knowing that it’s not about the destination, it’s about the journey and finding joy and love in every single day will serve you really well.

Katie: Well, it makes my heart so happy to hear that from a doctor who has seen and deeply researched all these pieces. And you mentioned some great resources. I will make sure the books you mentioned and the websites you mentioned, as well as, of course, all of your information are linked in the show notes. You guys, I highly recommend following Dr. Jenn. She is always releasing so much helpful information. And you’re right. I believe this is a complete symphony of all of these pieces working together. There’s no single bullet answer. And to me, that’s actually awesome news because we get to go on this journey of understanding our bodies, figuring out how to properly take care of and nourish them and thrive, not just get to a place of baseline, but a place of actually thriving. And like I said, I think this bioidentical hormone piece is one that I’m just kind of starting to research, realizing this may be on the horizon for me. And I think having resources like you of actually being able to start to learn the new paradigm, the new, like not the outdated data and the fear that we’ve gotten, but really what is the current information.

So on that, I know we touched a little about on the cancer side, and it seems like this is something that obviously impacts all women, not just women who have a genetic predisposition to cancer or who have already had cancer, but really all of us as your story even illustrated and how drastically different you felt when, and you had to completely shift your paradigm to even consider that as a step. So I can only imagine how life-shifting that was for you and your practice and your personal life, and in so much more. Are there any things we haven’t talked about related to this that you feel like are really important for women and especially in that perimenopausal and menopausal age to know, to be able to have informed choice on their health.

Dr. Jenn: I just think that the main thing is to know what the symptoms of menopause are. And I absolutely think that every single person who was born female needs to read Estrogen Matters because it will prepare you for that time in your life. We need to be talking about it. We need to put it out in the open. We need to take the shame away from it. You know, once upon a time, women did not survive into their 50s. So there wasn’t really a reason to talk about it. But now with the average survival being until into the 90s, we are talking about women living 40 and 50 years beyond their time of menopause. And so it’s really important to know how to navigate that time. And in order to not have the deterioration that comes, to learn to navigate it early and often.

So be ready to engage in bioidentical hormone replacement. Be ready to have a physician who is going to work with you. Be ready to have a physician who is literate in this area because it’s so important and no one should suffer. Pre-menopausal women shouldn’t suffer. Post-menopausal women shouldn’t suffer. Women with breast cancer shouldn’t suffer. We need to take that stigma of you just have to white knuckle it through. We need to remove that. You don’t need to white knuckle it through. And life is hard enough. We don’t need to add this challenge into things. And I think ultimately, we all want the same thing. We all want to live as long as possible and die young. Because dying old sucks.

Katie: Oh, absolutely. I truly love getting to talk to you because I feel like every response to a question could literally be a TEDx Talk because you deeply, deeply care and you’ve deeply done the research. You have the clinical experience and obviously such a heart for helping women, which I absolutely love. If people want to learn from you and to stay in touch with you online, as I would guess many people do after hearing from you today, where can they find you and what’s the best way to do that?

Dr. Jenn: So I’m on all the social media outlets at Dr. Jenn Simmons, and my Jenn has two N’s. My website is called Real Health MD, and there you can find a lot of resources. And if you want to learn about working with me, you can apply for a spot. I’m going to be honest, there aren’t a lot of them, but you can always apply and join one of our group programs, which is a great way of getting to work with me and getting lots of exposure to me. I have a podcast that you can listen to every week. It’s called Keeping a Breast with Dr. Jenn. We release every Monday. So join us there and you can get that anywhere you get your podcasts. I have a Facebook group, which is very active and I’m in there a lot. It’s also called Keeping a Breast with Dr. Jenn. Please pick up my book. It is a great Mother’s Day gift for all the women in your life that you love and care about. It is basically the user’s manual to prevent, reverse breast cancer and to live the life that you want and deserve and desire. That book is called The Smart Woman’s Guide to Breast Cancer. And if I do more, I don’t know. Oh, but definitely check out perfectionimaging.com because that is where you can find all the centers available to have that latest technology to screen for breast cancer without pain, without compression, without radiation, with the most accurate information that we have available today.

Katie: And I will put all of those links and the link to our first episode that really went deep on the screening side so that you guys can find those all at wellnessmama.com. And like I said, this is top of mind for me, both the hormone side. And if I get to the age of breast cancer screening, I will definitely be pursuing this new technology. And I will likely live Instagram that when I do that so that other people can get an insight into it as well. So you guys stay tuned. I will share.

Dr. Jenn: And remember with that screening, because there’s no radiation, because it’s 100% safe, young women can do it. Anyone can do it. So that’s the amazing part.

Katie: Yes, to get to have a baseline without the risk associated that we’ve had in the past. So I will definitely keep you guys all posted on my journey through both of those things. But Dr. Jenn, you are just such an amazing resource. I’m so grateful that we got to connect. And for everything that you’ve shared in today’s episode, I hope to have you back again in the future. But for today, thank you so much for your time and your expertise.

Dr. Jenn: Thank you so much for having me. It was a pleasure.

Katie: And thank you, as always, for sharing your most valuable resources, your time, your energy, and your attention with us today. We’re both so grateful that you did. And I hope that you will join me again on the next episode of the Wellness Mama podcast.

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