In this video, Dr. Simon addresses the “estrogen dilemma.” He presents eye-opening facts that challenge the misconceptions surrounding hormone replacement therapy. In this interview on 2ndAct TV with host, Silke Schwarzkopf, they also discuss how anyone struggling with the physical and sexual health effects of menopause can be treated with safe and effective hormone therapy for menopause management.

Silke Schwarzkopf:
I can’t believe that this isn’t being publicized more, that this is all wrong. So we really need to get that word out. Women are suffering.

Thank you so much for joining us again today on 2nd Act TV. I’m so happy to welcome back Dr. James Simon, board certified OBG/YN, clinical professor at George Washington University and the founder of IntimMedicine Specialist. Dr. Simon, thanks so much for being here again.

Dr. James A. Simon:
Silke, very nice to be here with you and I’m hoping everybody’s having a great day.

Silke Schwarzkopf:
Yeah, me too. Well, you know what, you were an absolute superstar here, the last time you were here. We had a conversation that was absolutely eye-opening about vaginal health. I mean, this has just gone through the roof. It’s just about a viral video and I’m going to link to it. So if you haven’t seen it, that you will see it. What came out that for me, and one of the reasons I wanted to have this conversation with you today is that it brought literally hundreds of comments to where people asked about estrogen. Just, oh, I just love what Dr. Simon says, and I understand what’s happening to my vagina, but I can’t do estrogen. I had breast cancer or my doctor tells me that I’m prone to getting it. I can’t do estrogen. And you and I, we’ve talked privately. I understand that there’s a lot there that’s just not… It’s not true. And I want to do a segment on that with you where you explain what is true. What is fact and fiction when it comes to what we call the estrogen dilemma?

Dr. James A. Simon:
Well, let’s first be very clear, there are two subjects. The first is, can a woman use estrogen or a medication that acts like estrogen in her vagina? If she’s had breast cancer or is at high risk for breast cancer, that’s a separate completely different question than can she following the treatment of her breast cancer use systemic hormone therapy? So I think one of the problems here is that both patients and practitioners confabulate or mix up those two very separate scenarios, local versus systemic. And unfortunately, the FDA has written in the labels of the vaginal products that are local, much of the information that’s in the labels of the systemic therapies, further confusing both practitioners and patients.

Silke Schwarzkopf:
I know that when we talked off camera, you have some just incredible data and slides that you explained to me that I think is so important for our audience to know where this perception, where it came from. And I mean, personally, I can’t believe that this isn’t being publicized more, that this is all wrong. So let’s talk about that. I think we can safely say, or you would say that local estrogen, there’s just no risk. We don’t even actually need to talk about that. It’s just do it if you need it.

Dr. James A. Simon:
Correct. So let’s be very clear and unambiguous. Local treatment of the vagina and vulva for symptoms related to menopause carries almost no risk and for sure no risk of increased breast cancer, first time or recurrence in women who had breast cancer in the past.

That is not my opinion. The overabundance of scientific information documents just those facts. And the Menopause Society has a document on women who are breast cancer survivors, which reinforces that point of view that I just mentioned.

Silke Schwarzkopf:
Yeah. And of course, you are one of the experts, as I like to say. I didn’t even say it this time. Your CV is so long. We need a whole segment on that. But you’re actually a past president of the Menopausal Society. I mean, we’re talking to one of the experts here that establishes or debunks or supports this kind of information.

Dr. James A. Simon:
Yeah. So thank you for that. And I’m very proud of the time that I spent as president of the Menopause Society.

Silke Schwarzkopf:
The study, what it found and the way it encapsulated findings was so misleading. I mean, definitely take us through some of that. Because that was just like, you’re kidding me, is what I was thinking the whole time you were talking.

Dr. James A. Simon:
So the Women’s Health Initiative study, which was a very important study, which came out just before I took the presidency of the Menopause Society, by the way. And it came out now more than 20 years ago, demonstrated or suggested that women had an increased risk of getting breast cancer if in fact they took hormone therapy. They said in their study that there were eight extra breast cancer cases per 10,000 women who used hormone therapy for an entire year. That’s 8 in 10,000, not 8%, not 8 in a hundred, 8 in 10,000, which turns out to be a very low risk of breast cancer if you believe it at all. And by the way, I do not believe it.

Because statistically in that study, there was some unusual findings that tended to contribute to those concerns that the investigators raised about the impact of estrogen and progesterone on hormone therapy… On breast cancer risk. What’s very interesting, and I do have a couple of diagrammatic expressions of this, was that women in that timeframe who were using hormone therapy for all kinds of reasons, hot flashes, night sweats, vaginal dryness, pain with sex, osteoporosis prevention, et cetera, they went off their hormones immediately and in a wholesale way. What do I mean by that? Well, women were using hormone therapy prior to the outcomes of those studies. Let’s say 2001, 2002, about 22% of all menopausal women were on systemic hormone therapy.

And when the study came out the first year, it dropped by about 50% to about 11%, and then it dropped again and again and again. And by 2010, it was about 5% of women who were menopausal using hormone therapy. Now, why is that all important? Well, first of all, there were a lot of women suffering when they went off their hormones, and some of them went back on to get the relief of those symptoms.

Silke Schwarzkopf:
A lot of men were suffering.

Dr. James A. Simon:
That’s true too. And you would expect that if all the women or half the women or 80% of the women went off their hormone therapy, that in those years following the women going off, you would see an increase in the risk of breast cancer or a decrease that would parallel the decrease in the use of estrogen. So again, you’d expect that when women went off their hormones, the risk of breast cancer would go down, wouldn’t you?

Well, that’s not what happened. And I’ll show you exactly that based on the Center for Disease Control, a federally funded organization, and in this graphic, I’ve superimposed the falling use of estrogen from 22% down to about 5% on those same years when the CDC was keeping track of breast cancer cases. And you could see that breast cancer cases went up when hormone therapy went down, suggesting that there’s a disconnect and that those two phenomena are not or are distantly related. And that’s a very important phenomenon that should be extremely reassuring to patients and their partners. That’s systemic therapy. Local doesn’t even get absorbed, so it’s even safer.

Silke Schwarzkopf:
Yeah, yeah. Well, and there’s just some absolutely… I’ll use the word ludicrous contributors to breast cancer or things, elements that cause breast cancer that are so much more than using estrogen. I really want to have you point those out because that kind of hits home if anybody’s worried about using estrogen.

Dr. James A. Simon:
Yeah, I think these are really almost funny.

Silke Schwarzkopf:
Yes.

Dr. James A. Simon:
Because we forget that a lot of issues in our environment that we take for granted also contribute to an increased risk of breast cancer. Let me tell you a couple of things. For example, any alcoholic beverage consumption contributes about the same amount of risk as was found in the Women’s Health Initiative. Eating french fries when you’re in preschool, I’m not kidding, has been associated with breast cancer risk as an adult woman. Working the night shift has an even greater risk of breast cancer than use of hormone therapy. And my absolute favorite in all of this is in a very important publication in the Journal of the American Medical Association or JAMA from 2004, showing that antibiotic use. Now, come on, everybody’s used antibiotics for something. Antibiotic use actually increases the risk of breast cancer and increases the risk of fatal breast cancer. So we need to be very careful about how we interpret risk, especially when there are consequences, adverse consequences of not using a particular therapy, whether it’s antibiotics or whether it’s hormone therapy. These are really important to distinguish and keep in mind.

Silke Schwarzkopf:
Right. So when we weigh the risk benefit, I mean the benefits are so much higher than the risk just based on these studies, and we’ll link to all this. I know this, it was shocking to me to hear that this exists and we didn’t know about it. I talk about this all the time too. So we really need to get that word out because again, the quality of life, people are just… Women are suffering.

Dr. James A. Simon:
I completely agree. The women are suffering, their intimate partners are suffering, their families are suffering, their work is suffering. It has a tremendous effect on sleep and cognitive function, performance at work and at home. These are all lumped together. And depending upon an individual woman’s circumstance, the risks may dramatically outweigh the benefits, partially outweigh the benefits. And there may be some women where the risks are greater than the benefits. But those kind of decisions need to be made on an individual basis with one’s own practitioner, but only if their practitioner really knows the truth. And that’s what we’ve been trying to bring up in our conversation today. That the risks are really quite low and the benefits are really quite high. And so we need to keep all that in mind for the average person, but for most women as well.

Silke Schwarzkopf:
So to encapsulate what we’re saying, I would ask you if a woman… And there’ll be lots of them and men watching go, well, how do I work with my practitioner with this? Do I go in there and say, “Hey, I know you told me not to take estrogen, but I saw a YouTube video with Dr. Simon and Silke, and they said, we can?” How do you manage that process?

Dr. James A. Simon:
So I think the first thing is you need to make sure that they’re speaking about the same use of estrogen that you are. No practitioner should blanketly say to a woman, they can’t use low doses of vaginal estrogen. This is a pretty much no harm, no foul issue, but I think many times gets confused with systemic use of estrogen, both by practitioners and by patients. For most women, especially those that are around the time of menopause, let’s call that between age 50 and 60. Most of them can use hormone therapy systemically with little or no risk. Little or no risk with some provisos based on their own individual risks for heart attacks, stroke, dementia, breast cancer, et cetera. But that’s a big long conversation, individualizing that risk. If a woman wants to start on systemic hormone therapy and she has not had it from 50 to 60 and is going to start on it at age 60, there’s a whole nother conversation that needs to occur because her own underlying risks have gone up in that 10 years since her last menstrual period. And those need to be taken into [inaudible 00:16:10].

Silke Schwarzkopf:
Into consideration, yeah. Well, lots to think about here. And I hope that we answered a lot of the questions, or at least addressed a big overriding question that we received on our last video about using hormones and the risk of cancer. It’s just such an important conversation. I mean, this is stuff that can literally change your life, especially if you’re suffering from the menopausal effects. So do look into it, educate yourself about this, look into the studies and the information that Dr. Simon presented here today. Before we wrap up, is there anything else that you want to add in the segment, something I didn’t ask that you think is important our viewers know?

Dr. James A. Simon:
So Silke, one of the things I’d like to add in which most people don’t know, and we’ve been talking about breast cancer specifically. Menopausal hormone therapy, systemic hormone therapy in multiple studies has documented a significant decrease in a woman’s lifetime risk of colon cancer. You don’t often even talk about that. So the focus on breast cancer’s been a distraction from the whole picture of a woman’s benefits from hormone therapy.

Silke Schwarzkopf:
Hormone therapy. It’s so interesting, so interesting. Well, again, thank you so much for your time, Dr. Simon. This is such an important conversation. We will have links to everything of course, in the show notes. You can get in touch with Dr. Simon directly if you want to. So can your practitioner. Dr. Simon does educational and medical teleconferences. Is that’s what it’s called.

Dr. James A. Simon:
[inaudible 00:17:56] call them educational televisits or telemedicine visits.

Silke Schwarzkopf:
So all those links will be in the show notes. And I look forward Dr. Simon to have you back soon on 2nd ACT TV.

Dr. James A. Simon:
Thank you.

For more information about menopausal health, contact Dr. Simon at IntimMedicine Specialists. To schedule an appointment, call our office at (202) 293-1000 or https://intimmedicine.com/contact-us/.