It’s About Time…For an Estrogen Fix

It’s About Time…For an Estrogen Fix

Are you confused about hormones? Are they right for you? When do you start them? Stop them? Which one? How much? What kind? Are bioidentical hormones safer?


If any of that sounds like you, you’re not alone!


Not many medications affect so many people and are so misunderstood. We need an Estrogen Fix. Here’s how it all got so crazy confusing, why I wrote The Estrogen Fix, and why you should read it.


In 2002 the first Women’s Health Initiative (WHI) study was abruptly shut down early at the 5.2 years mark after preliminary data indicated a small, measured increase in risk of breast cancer and cardiovascular heart disease among women who took the estrogen and synthetic progesterone called Prempro. Since this was a prevention study, any increased health risk required that it immediately be discontinued. You can imagine that when the NIH shuts down a study and it becomes front-page news that suggests the medicine you are taking causes breast cancer and heart disease, you would panic if you were taking that medication. And panic causes lower objectivity. No one took the time to read the fine print.


Seven months later my wife, Sharon, had surgery that threw her into early menopause and  her doctors were reluctant to treat her. I transitioned from being one of the countries top infertility experts to putting all of my attention into menopause and hormone therapy. Here’s what I found out.


The WHI studies had a “fatal” flaw. Instead of comparing apples with apples, they compared apples with oranges. They compared a placebo group of mostly younger women (mostly 50 to 59 years old) to a study group of mostly (75 percent) older women (mostly 60 to 79 years old). And to make matters worse, more than 60 percent of the women in the older group were lifelong smokers, many with some form of heart disease. Many in the older group also had diabetes and high blood pressure and were overweight. It’s no surprise that older women with more medical problems would have poorer outcomes–and they did.


Yet when the NIH released the 2002 WHI results, the risks were placed solely at the feet of the Prempro, which, as you’ll discover, did play a role; but the study did not consider preexisting risk factors or how much time had passed since each woman entered menopause. “Estrogen” was blamed entirely as the culprit. It was like comparing car death statistics between drunk or sleep-impaired drivers and those who were sober and rested. You don’t have to be a research scientist to know that this was poor science and poor analysis of the information. As mentioned, since this was a prevention study, any reported increase in risk meant the study had to be discontinued immediately.


The researchers running the study knew the women taking Prempro were not comparable with the women in the control group because of the significant differences in age, but they didn’t know how to overcome this hurdle. When the researchers first started recruiting subjects for the study in September 1993, so many menopausal women were already taking Premarin (estrogen only) or Prempro (estrogen plus synthetic progesterone), they had difficulty finding age-matched women for the control group who weren’t taking it.


Instead they put together a group of women who were mostly aged 60 and over, all of whom were no longer taking Premarin or Prempro. But many of these women were heavy smokers and had poor heart health, diabetes or high blood pressure. Yet amazingly, all that crucial health information and their age differences were overlooked and under-reported when the WHI researchers wrote their conclusions about the safety and efficacy of Prempro. Many years later, these poorly analyzed, incorrectly interpreted data remain the basis of the misgivings and fears attached to estrogen.


The patients who come to see me today at Beth Israel Hospital and Harvard Medical School as they enter menopause and the coaching clients I help who live far away are still talking about those erroneous conclusions. I hear over and over again from these women that they feel they have no choice but to tough out their menopausal symptoms. It’s as though taking any form of estrogen would be causing them early death. Almost every woman I see fears taking estrogen because of the outdated and incorrect WHI information. Once I explain the facts and reassure them, they become eager to discover their estrogen window and how to achieve an estrogen fix.


A Menopause Breakthrough


The confusion from the WHI study left me wondering what other studies, clinical trials, and information revealed about the positive versus negative effects of estrogen. I started reading all the estrogen information I could find to understand why estrogen continued to be the 800-pound gorilla in the room for menopause, women, and their doctors. I analyzed years of data, poring over major and minor studies and hundreds of peer-reviewed journal articles and papers presented at meetings and symposia. I interviewed fellow experienced doctors and top researchers, including Drs. Pauline Maki, Phil Sarrel, Wulf Utian, Isaac Schiff, Mary Jane Minkin, JoAnn V. Pinkerton, JoAnn E. Manson, Sara Gottfried, James A. Simon, Andrew Kaunitz, and others as editor of The Hot Years – My Menopause Magazine.


I did this because menopause is one of the most challenging periods in a woman’s life. As an ob-gyn and NAMS Certified Menopause Practitioner, I witness on an almost-daily basis how menopause symptoms affect the quality of my patients’ lives and their performance in the workplace. Surely there had to be some evidence-based way that estrogen could be used to bring relief.


Each article, presentation, and interview contained a golden nugget of information that together created a pot of gold–something really valuable to help Sharon, my patients, and women everywhere. I came to realize there is such a thing I call the estrogen window, the time in a woman’s life when she can most safely begin taking estrogen and benefit from it in many ways.


Consider the hormone insulin for a diabetic patient. Taken at the right time, insulin regulates blood sugar, keeps diabetes under control, and wards off potentially devastating side effects. If insulin is given at the wrong time, a diabetic can go into diabetic shock. For estrogen, too, timing is very important. As a medication, it is not about being either good or bad. It’s all about the timing. If taken at the right time, estrogen provides dramatic relief for the most troubling menopausal symptoms while at the same time providing a host of benefits, including:


  • Extended protection from heart attacks and heart failure


  • Reduced risk of Alzheimer’s disease and other forms of cognitive decline


  • Reduced risk of osteoporosis


  • Beneficial cosmetic effects on the structure and resiliency of the skin


  • Relief of sexual problems such as vaginal dryness and painful intercourse


  • Relief from troubling and sometimes disabling hot flashes


  • Improved quality of sleep


  • Stabilized mood, particularly in women who have a known mental health diagnosis


  • Lowered risk of type 2 diabetes


  • Support for bladder tissue and lower risk of recurring urinary tract infections


Taken during a woman’s estrogen window, estrogen accomplishes all these astonishing feats with minimal increased health risks. It becomes an Estrogen Fix. How long her estrogen window stays open depends on two things: which estrogen-containing medicine is used and which symptom or condition is being targeted, which I explain throughout The Estrogen Fix Book.


If the same woman takes the same drug after her estrogen window has closed, there may be an increased risk of serious side effects. Her odds for developing cardiovascular disease, blood clots, cancer, and cognitive decline become higher. But remember: It’s not the estrogen that is bad; it’s the Provera combined with the estrogen and when it is taken during a woman’s life, or the timing, that are bad.


Too many women believe they have to struggle through this phase of life without assistance, and somehow if they do that and forgo estrogen, they will come out on the other side without any consequences. Others think that if they take estrogen and get almost immediate symptom relief, they will be diagnosed with breast cancer or heart disease a few years down the road. Nothing could be further from the truth. The Estrogen Window will help you “figure it out” so you won’t have to “tough it out.”


It’s ironic that the treatment women have avoided because they fear increased odds of developing a dreaded disease is in fact the very treatment that can offer greatly expanded protection against developing those same potentially deadly conditions after menopause. The key to using estrogen successfully is to take the right estrogen and to take it at the right time for at least 5 to 7 years following the onset of menopause.


It has taken decades to undo the damage done by one flawed study and change people’s minds, even doctors’, despite efforts from members of NAMS (North American Menopause Society), ASRM (American Society for Reproductive Medicine), and ACOG (American College of Obstetricians & Gynecologists).


On October 6, 2016 at the NAMS Annual Scientific Meeting, Executive Director JoAnn V. Pinkerton, MD revealed their latest position statement about HT (Hormone Therapy). It represents a consensus of over 20 international experts.


The Bottom Line: Overall, HT has clear benefits for the treatment of hot flashes and bone loss prevention. These benefits are most favorable among women aged younger than 60 years who are within 10 years of menopause onset and have no medial reasons they can’t take HT. Women older than age 60 who begin HT beyond 10 years of menopause onset appear to have a less favorable benefit-risk ratio because of elevated risks of coronary heart disease, stroke, venous thromboembolism, and dementia ie – it’s all about the estrogen window to get an estrogen fix.


The science is clear: Based on clinical studies that have appeared in multiple peer-reviewed medical journals, estrogen can be taken safely if used in the right way at the right time for the right length of time.


If you’re like my patients and coaching clients, you probably have a lot of questions: Is estrogen really as safe as you say? Do I take pills, use a cream, or apply a patch? What’s the right dosage for me? When should I start? How do I know when to stop? Which estrogen should I take? Which progestogen should I take? All your questions will be answered in The Estrogen Fix, so you’ll be prepared to have an informed conversation with your physician or health-care provider.


The paperback edition of the book will be in bookstores September 19. But you can purchase it early at and get some very cool free gifts for buying your copy early.


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