Postmenopausal Hormones: Helpful Or Harmful? with Dr. Elizabeth Boham - Transcript

Dr. Elizabeth Boham (00:00): What's really important is understanding why that woman's coming in asking that question of, should I be on hormones? What are the symptoms they're really dealing with? And then ... because that really impacts how we attack it. Dr. Mark Hyman(00:15): Welcome to the Doctor's Farmacy. I'm Dr. Mark Hyman and that's farmacy with an F, F-A-R-M-A-C-Y. A place for conversations that matter, and if you're a woman going through menopause or you're a man living with a woman going through menopause, then you should listen to this podcast, because it's with my friend and colleague from the UltraWellness Center, Dr. Elizabeth Boham. This is a special episode of the Doctor's Farmacy House Call, where we take you deep inside what we do at the UltraWellness Center and how we help thousands of people suffering from problems that don't get answers in most places they go. Dr. Mark Hyman(00:42): So today, we're going to talk about this problem of hormones. Liz, you are an expert in hormones for reasons that you probably wish you weren't, which is that you had breast cancer many years ago. You're a very unusual physician. You're a doctor, an MD, who studied nutrition as an MD and did a fellowship. You also an RD, a dietician and an exercise physiologist, and you're on the faculty of the Institute for Functional Medicine and trained physicians all over the world. So, welcome to the Doctor's Farmacy again. Dr. Elizabeth Boham (01:10): Thank you, Mark. Thanks for having me. Dr. Mark Hyman(01:10): You might be my most prolific guest. Dr. Elizabeth Boham (01:13): It's just great being here. Dr. Mark Hyman(01:14): So today, we're going to talk about hormones and particularly around menopause. The big question is, should I or shouldn't I? Should I take hormones or should I take hormones? I remember when we worked together at Canyon Ranch years ago, there was a general view that hormone replacement was God's greatest gift to women. I remember questioning this because early data was coming out in the '90s that questioned its safety and its increasing risk for breast cancer and stroke and heart disease. If there were so many studies that showed it was a panacea that it would prevent heart disease, breast cancer, help them and prevent dementia, make them vital and healthy and wonderful. I remember this one woman coming up to me in this lecture after I gave a talk to challenging some of the conventional notions, which is I think what I've done my whole life. Dr. Mark Hyman(02:11): She said, "My doctor said if you don't prescribe hormones, it's malpractice." I was like, "Okay." That was the view. Then we had this incredible study that came out called The Women's Health Initiative. It contradicted the earlier studies, which was the Nurses' Health Study, which is more of a population study where they basically followed women over many years. The women who took hormones seemed to do better. So, that's what led to this incredible prescription of hormones that over 50 million women were taking in America. Then when they did an actual study, randomized controlled trial funded by the NIH, which was a billion dollar study. So, it was massive study. Dr. Mark Hyman(02:50): It actually had to be stopped because the women who took the hormones, the Premarin and the Provera, which was the reigning hormone prescription at the time, which we'll talk about the pros and cons of these kinds of hormones, the women actually did worse. They had worse heart attacks, cancer, strokes, dementia, blood clots. It wasn't fun. So, literally overnight 50 million women stopped taking hormones, which was a national emergency. So, we want to dig into this because I think still women are a little shy about it. Doctors are a little shy about prescribing it. It's a more nuanced conversation than just yes or no. It's for who and how and when and how much and how do you take it and how do you monitor it and what do you look for. It's complicated. This is really what functional medicine is great at is looking at complicated problems and thinking through them on a personalized approach, which is very different than, "Oh, you have menopause? Take hormones." Dr. Elizabeth Boham (03:54): Yeah. I mean, I think even OBGYNs, conventional doctors, they feel inadequate in terms of their ability to treat women with menopause. Most of us weren't trained enough in medical school in terms of how do we deal with some of these symptoms of menopause and definitely weren't trained in that functional medicine approach where we're treating everybody as an individual. I agree with you, I think this is an area where it's so critical to deal with each woman as an individual and figure out what exactly is she concerned about, what are her issues and where do we need to focus with treatment. Dr. Mark Hyman(04:30): Absolutely. It's so important because a lot of women suffer and they're not getting help. I find that we don't do a good job of evaluating why hormones get out of balance, because there are some countries where women don't really describe a lot of menopausal symptoms like in Japan, although probably more now, but they really didn't have even a word for hot flashes. Dr. Elizabeth Boham (04:55): Yeah. Right. Dr. Mark Hyman(04:55): So, let's say to sort of from the beginning, when you see a woman who comes in with menopause, what are the kinds of symptoms and issues that they might be facing and how do you evaluate those? Dr. Elizabeth Boham (05:02): Yeah. So, just in terms of the definitions, perimenopause is those years before you go into menopause. So typically, a woman goes into menopause between the ages of 45 and 55. That's average. The years before they go into menopause is called perimenopause. During those perimenopausal years, women may be having anovulatory cycles there. They might not be ovulating every month and they have variability in terms of their hormone levels. Their hormones might be higher or lower, different months. During perimenopause, we get a lot of symptoms, not every woman that's for sure. Not every woman gets symptoms, but for some women peri-menopause comes with more irritability, more hot flashes, more night sweats, more trouble with sleep. Then when you go into- Dr. Mark Hyman(05:54): Premenstrual migraines, heavy bleeding, clots, irregular cycles. Dr. Elizabeth Boham (05:58): Right. Some months they might have- Dr. Mark Hyman(06:00): Worsening PMS. Dr. Elizabeth Boham (06:01): They might not have a period one month and then the next month, they may have a heavy period. Those symptoms can change from month to month. They can be really tricky one month and then not so bad the next month. This can be really a tricky time for some women. Then when you go into menopause, which is considered you haven't had a period for a year, there's been no period in one year, you're considered post-menopausal or menopausal. Then, you can still have, for some women, still have hot flashes and night sweats. For some women, that's when vaginal dryness becomes more of an issue, lower libido becomes more of an issue and trouble with sleep still stays for some women. Some women will struggle with their bone density because of that decrease in estrogen that can [crosstalk 00:06:44] Dr. Mark Hyman(06:44): Even menopause brain. Dr. Elizabeth Boham (06:45): Yes. Oh yeah. I just forgot what I was going to say. So, there's a lot of different symptoms that we're dealing with, and what's really important is understanding why that woman's coming in asking that question of, "Should I be on hormones? What are the symptoms they're really dealing with?" Because that really impacts how we attack it, how we help them through that process. Dr. Mark Hyman(07:08): Yeah. So, like you said, some women don't really suffer much and there's a lot. So, what are the reasons why women might have worsening hormone symptoms? What are the things that we can look at and modifying their lifestyle or their environment that may be having negative impacts? Because you don't want to jump right to hormones therapy. Dr. Elizabeth Boham (07:24): No. Lifestyle makes a huge difference. It makes a huge difference for so many women. We also know it depends on how a woman goes into menopause. So, if somebody has a total hysterectomy all of a sudden or had chemotherapy, which I can tell you about my situation, all of a sudden your hormones are going to shift right away. Then you can be more symptomatic versus if a woman is going through that perimenopausal time in a more gradual change, they have very different symptoms and very different severity in symptoms. So, that's important to pay attention to. Dr. Elizabeth Boham (08:01): We know that lifestyle makes a huge impact. If we're taking care of our adrenal glands, right? Those glands that sit up on top of our kidneys that help us manage stress, we know that we can help a lot of our symptoms. When a woman is practicing meditation, stress reduction techniques, they can really cut back on their hot flashes significantly. If we cut back on alcohol, that can help with hot flashes and night sweats and sleep for sure. By balancing our blood sugar through a good healthy diet, that helps with those symptoms as well. Dr. Mark Hyman(08:32): High fiber has a big role on estrogen metabolism. Dr. Elizabeth Boham (08:34): Yeah. So, there's so many ways you can attack this from a lifestyle perspective, but I really- Dr. Mark Hyman(08:42): [crosstalk 00:08:42] women are stressed, they drink too much, they eat too much junk food, sugar, don't exercise, don't sleep enough. They're going to have more problems. Dr. Elizabeth Boham (08:50): Absolutely. So, as you mentioned, when I was 30, I had breast cancer. So, I went through surgery then chemotherapy and radiation therapy. Dr. Mark Hyman(09:00): Medical menopause. Dr. Elizabeth Boham (09:02): Yes, medical menopause. So, it's crazy. All of a sudden, I'm like, "Okay, now I'm getting educated in what this thing called menopause is." Because when they give chemotherapy, it kills off all the fast dividing cells. So, there's all of those ... ovaries, the cells in the ovaries, the O sites, get damaged right away. So, you have many, many women will go into ... depending on the chemotherapy, but many women will go into menopausal symptoms right away or go into menopause right away. So, all of a sudden, I'm 30 years old and I've got hot flashes and night sweats and vaginal dryness. My sleep changes and on top of that, I've got cancer. So, it was no fun. Dr. Mark Hyman(09:48): All that. Dr. Elizabeth Boham (09:49): It was no fun. But, I was lucky in the sense that ... I guess it's lucky I was so young when I had the chemotherapy that my periods actually came back. So, I started getting my cycle again a few months after treatment and then got pregnant and was able to have a couple kids, but ever since then, my periods were really erratic. They were up and down and back and forth. I was ... and then most women who go through chemotherapy, they say about you usually ... if you do get your period back, then you typically go through menopause about five years earlier than average. That's typical and everybody's different. So, for me, I stopped having my period over three years ago or so. So, I went into ... I know, right? Dr. Mark Hyman(10:37): I don't know. Dr. Elizabeth Boham (10:38): You learn something new every day. Dr. Mark Hyman(10:45): I was wondering. I didn't want to say ... then it's kind of like, "Oh, don't say that. Don't ask that question." Dr. Elizabeth Boham (10:47): Nobody's going to touch me with hormones with a 10 foot pole, right? Once you've had breast cancer, you're not really using a lot of hormones for handling all these symptoms that you're going through. So, it really was a time where I was able to really understand what all my patients were going through, appreciate what it feels like when your hormones are fluctuating and they're going up and down and back and forth, and really understand what things are really helpful outside of hormone therapy. It doesn't mean that I don't use hormone therapy with my patients, but there is a lot of other things we can do as well that can be helpful. Dr. Mark Hyman(11:20): The other thing we didn't even talk about is that the other things that screws up your hormones is environmental toxins. Dr. Elizabeth Boham (11:26): Yes. Dr. Mark Hyman(11:26): Plastics, pesticides, chemicals, and we're all toxic waste dumps. So, these are called xenoestrogens or foreign estrogens that interfere with our hormone metabolism and our hormone function and bind to the same receptors and can actually cause cancer, but also can lead to all these horrible, horrible, symptoms in women now. Dr. Elizabeth Boham (11:44): More symptoms, more PMS for women, infertility for women and men even. More symptoms of struggling through the whole menopausal process. Dr. Mark Hyman(11:56): Also nutritional deficiencies, right? Dr. Elizabeth Boham (11:57): Uh-hmm (affirmative). Dr. Mark Hyman(11:57): So, we don't just check your hormones like a regular doctor. We look at the various ways that hormones are metabolized in the body. So, there are many different kinds of estrogen and there's different estrogens at different times of your life. There's different types of estrogen metabolites, and they all can have different impacts. Sometimes women need much higher levels of certain vitamins that help metabolize the estrogens better. Dr. Elizabeth Boham (12:18): So, if you choose to use hormone therapy to help a woman, it's important that you look at some of these things, like how are they handling it? How are they metabolizing it? How are their genetics involved? Dr. Mark Hyman(12:29): Hey everybody, it's Dr. Hyman. Thanks for tuning into the Doctor's Farmacy. I hope you're loving this podcast. It's one of my favorite things to do and introduce to you all the experts that I know and I love, and that I've learned so much from. I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. In it, I share my favorite stuff from foods to supplements, to gadgets, to tools, to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else I promise. All you do is go to to sign up. That's, P-I-C-K-S, and sign up for the newsletter. I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer. Now, back to this week's episode. Dr. Elizabeth Boham (13:25): So, I had a woman who came in to me the other day and said, "Well, should I be taking hormones? And if so, what should I take?" So, I think as you were mentioning, it's really important that we treat everybody as an individual and try to figure out what issues they're dealing with and think about what ways we can help them through some of their symptoms. Dr. Mark Hyman(13:43): Yes. We look at a lot of different things, including the nutritional levels, things like B6 and folate that have effect on estrogen metabolism. We look at things you might not think of looking at like poop. I mean, how does a stool test help? Well, I've seen women, for example, with really abnormal gut flora, particularly have high levels of certain bacteria called Clostridia that basically unwraps the estrogen that's wrapped up by our liver and excreted in your gut and supposed to end up in the toilet, but it goes through your gut and it hits this bacteria, and the bacteria literally unwraps it from its packaging and you reabsorb it. So, you get high levels. Dr. Mark Hyman(14:22): So, sometimes it's increasing certain types of fiber or certain types of probiotics like Saccharomyces or maybe taking even some herbs to kill the ... or even medications sometimes that kill the bacteria that can help to improve estrogen metabolism. So, we have to look at this holistically. Toxins in the gut and nutritional levels and all these other variables that affect hormones to optimize your own hormone levels. Then if we need to, we'll think about hormone replacement. So, talk about your patient who came in with menopausal issues and how you approach it, how you decide, does this woman get hormones? Does this woman get herbs? Does this woman need pills or shots or vaginal or topical? How do you navigate all that? Dr. Elizabeth Boham (15:06): Yeah. So, as we were talking about, it's really important to take a really good detailed history and think about what their issues are because every woman is an individual. Then if we do choose to use hormones, we need to pay attention to those questions of how is that person handling it, is it a safe thing for them, and how can we give it in a safe way? I think that one of the things that people are always arguing about or questioning is well that Women's Health Initiative was using Premarin and Prempro, right? It was using those non bioidentical hormones. If we give hormones that are bio identical, right? Identical to what the own body makes, would that be safer? Dr. Mark Hyman(15:47): Yeah. Dr. Elizabeth Boham (15:47): Of course, that would be safer. Is it safe enough? Right? Dr. Mark Hyman(15:50): Right. Dr. Elizabeth Boham (15:50): So, those are those questions that were- Dr. Mark Hyman(15:52): What is Premarin? Dr. Elizabeth Boham (15:54): So, it comes from pregnant horse's urine. So, it's an equine estrogen, and it's not identical to what- Dr. Mark Hyman(16:00): Premarin, pregnant mare's urine. Dr. Elizabeth Boham (16:02): Yeah. It's not considered identical, which is what your own body, the structure of hormone, the estradiol or estrogen that your own body makes, it's not the same. It was also an oral estrogen, and we know that oral estrogens are more pro-inflammatory in general. Dr. Mark Hyman(16:23): They have to go through your liver. Dr. Elizabeth Boham (16:24): They have to go through the liver. They increase inflammation for some people, even more than others, but they increase inflammation in the body and they're associated with a higher risk of blood clots. Dr. Mark Hyman(16:33): Inflammation, they affect your triglycerides, the liver function tests. If you drink alcohol with it, it's nasty and it really spikes your hormone levels. Right? Dr. Elizabeth Boham (16:42): Right, right. So, then people argue, "Well, if we do it transdermally, if we do a patch- Dr. Mark Hyman(16:49): Topically. Dr. Elizabeth Boham (16:50): Yep. You're right, exactly. Topically, through the skin. If you do a patch or a cream or an oil of estrogen, wouldn't that be safer? I think probably yes, but we have to also pay attention to, is it without any risk? Probably no. Right? So, you're always really looking at each individual woman and determining what their issues are, and do they need hormones? Dr. Mark Hyman(17:14): How does it affect them, right? What do their blood levels happen after they take it? Dr. Elizabeth Boham (17:18): Exactly. Dr. Mark Hyman(17:19): Right? I mean, the same dose given in the same way, whether it's oral or topical can have profoundly different effects on different women depending on their genetics and their nutritional levels and the gut and all these factors. So, you can't really tell unless you measure how women are and then what are the estrogen metabolites, which were measured in addition to normal estrogen. We look at the urine and we can say, "Oh, this is being metabolized well and not causing a problem." or "No, this is producing cancer causing estrogens." Dr. Elizabeth Boham (17:44): Yes. Dr. Mark Hyman(17:45): Right? Dr. Elizabeth Boham (17:45): Exactly. So, we do know that even bioidentical estrogen or even our own body's estrogen impacts our risk of breast cancer. Dr. Mark Hyman(17:56): For sure. Dr. Elizabeth Boham (17:58): So, giving extra estrogen is not without risk. That's for sure. Right? When I'm working to decrease a woman's risk of breast cancer, I'm always thinking about how I can help them metabolize and get rid of and lower their total body's estrogen. So, we do recognize that even if it's a bioidentical safer estrogen, there is some risk, right? We don't know how much yet. We need better studies, because even ... I was looking at a meta analysis that was done in 2019, looking at a bunch of different studies and tons of women. There was a slight increased risk of breast cancer for the women on estrogen and progesterone therapy. Dr. Mark Hyman(18:35): Even bioidentical? Dr. Elizabeth Boham (18:36): Well, see, that's the thing, because this study was throwing all these women in together. So, a lot of them were on some of the non bioidentical estrogens. So, we just need more research on the bioidenticals I think to really tease this. Dr. Mark Hyman(18:50): Yeah. But, here's the problem. They're basically not patentable there. Dr. Elizabeth Boham (18:57): Well, I mean, some of the transdermal estrogens that you get at CVS or any local drug store that you can get by prescription are officially bioidentical. Right? If it's estradiol- Dr. Mark Hyman(19:08): They are but they're more likely that they're generic forms of them, so nobody is going to spend $100 million dollars doing a study on it. So, it's hard to get the data. Dr. Elizabeth Boham (19:15): It's hard to get the data. Yeah. Like we said, everybody's so different. Right? So, I mean, I always explain that to women, that the word bioidentical just means it's identical to your own body's estrogen, but we often give compounded estrogens, but we also ... meaning you go to a compounding pharmacy, but sometimes we'll use estrogens that are bioidentical that you can get at your local prescription, local drug store. Dr. Mark Hyman(19:37): Probability like Climara or Estrace patches. Dr. Elizabeth Boham (19:39): Exactly. Yeah. So- Dr. Mark Hyman(19:42): So, tell us how you decide whether you do it orally or topically or vaginally or under the tongue. There's a lot of ways to give hormones. Dr. Elizabeth Boham (19:52): So estrogen, I typically don't give orally because of that increased risk of inflammation and blood clots. I usually give it transdermally if I'm going to give it. The main reasons we're using estrogen is for hot flashes, sometimes sleep and definitely bone density. So, for those women, we do know that it can help improve bone density. So, there's a subset of women we may use it for. Then we'll use vaginal estrogen for vaginal dryness. Dr. Mark Hyman(20:18): That doesn't get absorbed so much. So that's- Dr. Elizabeth Boham (20:20): It's really got a low systemic absorption. Of course, probably some of it does, but there's been multiple studies on vaginal estrogen with high risk women. So, women who've had breast cancer or who have breast cancer, a lot of them, because of all the therapy, the treatment, the Tamoxifen or the chemotherapy are really struggling with vaginal dryness. So, they've done a lot of studies on vaginal estrogen in that group of women. There really is a very, very low if any risk. So, most oncologist feel very comfortable with that high risk group of women using vaginal estrogen if it's needed. Dr. Mark Hyman(20:56): Yeah. Then, there's other hormones we might use, right? Dr. Elizabeth Boham (21:01): Yes. Dr. Mark Hyman(21:01): Progesterone, testosterone. Dr. Elizabeth Boham (21:03): Yes. Dr. Mark Hyman(21:03): Yeah. Dr. Elizabeth Boham (21:04): So, progesterone, we can give orally. We can also give it through the skin. Typically, I'll use progesterone orally if a woman's really struggling with sleep. It's very, very calming. So, it's- Dr. Mark Hyman(21:20): It binds in the same brain receptors as Valium. Right? Dr. Elizabeth Boham (21:22): Uh-hmm (affirmative). That's like calming. Our progesterone's high when we're pregnant. Then we can use it through the skin also. That can be used both to regulate periods if somebody is still in perimenopause. It can be used for anxiety. It can be used for sleep. It can be used along with your estrogen. So, if a woman still has her uterus, it's necessary. If you are going to give estrogen, that you give progesterone along with it. Dr. Mark Hyman(21:50): Yeah. Dr. Elizabeth Boham (21:51): Then, like you said, testosterone. Testosterone's a nice- Dr. Mark Hyman(21:54): Wait one ... Dr. Elizabeth Boham (21:54): Yeah. Dr. Mark Hyman(21:55): So, the progesterone that was prescribed when I went to medical school and it was part of these studies is called Provera or medroxyprogesterone, which is a synthetic progesterone that makes women feel horrible. I always joke it makes them fat, hairy, and depressed. They get facial hair. They gain weight. It's actually what they use to stimulate appetite in cancer patients, something to eat. It actually also causes depression. So, it's not a great drug. If doctor wants to prescribe that for you, run away the other direction. Dr. Elizabeth Boham (22:31): Right. So, with the micronized progesterone or that again natural progesterone, you'll get the benefits of progesterone without those side effects. So, that's what we'll typically use. You're absolutely right. Dr. Mark Hyman(22:44): I've seen it incredibly work for pre-menstrual migraines, that sleep anxiety, heavy periods, cramping, heavy bleeding, all that. The testosterone you're going to go into a little bit, because I think that's really important. Dr. Elizabeth Boham (22:58): Yeah. One of the great things about testosterone, when we use it, is it can help us use less estrogen. So, testosterone can be helpful because it can get converted into estrogen, but also then you just don't need as much estrogen for somebody's symptoms. So, we'll see that sometimes. We can use it from a libido standpoint. For some women, it's helpful from a vaginal dryness standpoint for some women. So, sometimes when we give a transdermal hormone therapy, we'll use an estrogen progesterone testosterone combination. Dr. Mark Hyman(23:29): Yeah. Little magic drops. Dr. Elizabeth Boham (23:31): Magic drops. Dr. Mark Hyman(23:32): Yeah. So, it's important understand that this has got to be personalized. If there's a lot of factors that you can do that and then that you do with taking hormones to fix your hormones, which is what we do in functional medicine. We're good at diagnosing what those issues are. That maybe seeing weird things that you don't think about like fixing your gut or getting rid of environmental chemicals in your life or taking the right nutrients to optimize your hormone metabolism or to mitigate risk. So, often if I do actually put women on hormones, I'll mitigate the risk by using the right nutrients to help them metabolize their hormones properly like Diindolylmethane and various things like lignans from flaxseeds and other things you can add to the diet or to supplements that actually help with the metabolizing. Dr. Mark Hyman(24:11): If you need to take hormones, sometimes it's also the question of how long, right? So, you might need a short course of hormones through the worst part of menopause, if all the traditional lifestyle and other factors aren't working, that's okay. Because the risk of cancer with estrogen really is about the dose, the delivery mechanism, right? Oral and the duration that you take it. So, I always want to use topical, the least amount possible for the shortest time that I can to help with whatever symptoms are. Then if they need longterm vaginal estrogen and a little topical clitoral testosterone, that usually does it for most people. Dr. Mark Hyman(24:55): For me, I get really angry when I see women suffering from these problems that have solutions, right? Whether it's PMS or fibroids or dysfunctional bleeding or PCOS or endometriosis or menopausal symptoms or perimenopause or osteopetrosis, these are not the curse of being a woman. These are things that are out of balance that need to get assessed and fixed. That's what functional medicine does. It's really different than just going your traditional doctor, saying pretty much before menopause everybody gets the pill, which has its own problems. Then everybody after, gets hormones and often they'll get the- Dr. Elizabeth Boham (25:40): Or they get antidepressants, right? Dr. Mark Hyman(25:42): Antidepressants, right. Or they'll get hormones that are problematic like oral hormones or Premarin or Provera which are still commonly prescribed, which is shocking to me. Dr. Elizabeth Boham (25:51): Yeah. Dr. Mark Hyman(25:53): I think that this is a really important area for people to understand particularly women and people who live with women, because it just creates such disruption in people's lives. It's so unnecessary. Dr. Elizabeth Boham (26:04): Right. Dr. Mark Hyman(26:04): So, I encourage anybody who's listening, anybody who struggles with these issues to think about seeing a functional medicine doctor here at the UltraWellness Center in Lenox, Massachusetts, we're doing virtual visits now. So, we can see people from anywhere in the world. If you don't want to go outside, you can stay in your bed and get evaluated and you can also get home testing. We'll literally send someone to your house to go get your labs drawn. So, we can do this. You can certainly come see us still. We have a great team here of physicians and nutritionists and physician's assistants, and health coaches. I really have an incredible approach to really getting to the root cause of what's going on and helping you reclaim your health. So, let's talk about how we evaluate and treat these patients here at UltraWellness Center. Give us a few short cases. Dr. Elizabeth Boham (26:48): Yeah. So, I had a woman the other day, 50 years old, and she was really struggling with hot flashes. So, her periods were now irregular. She was still getting her period, but over the last couple of years, they'd really spaced out. In fact, for the three months before she came in to see me, she hadn't had a period. So, her hot flashes and night sweats were really, really impacting her. Her sleep was all over the place. She used to have great sleep and now her sleep was ... she was waking up all night long, taking the covers off, putting them back on. She said, "I need to do something." Dr. Elizabeth Boham (27:24): So, of course we started with all the lifestyle stuff, right? We cut back on her alcohol. We had her start doing relaxation exercises because we know that really helps with hot flashes. We cleaned up her diet. I gave her some magnesium and black cohosh, and that was really helpful, but not helpful enough. So, she was really still struggling with sleep. She's like, "I need to do something because I am so irritable because I'm not getting good night's sleep. Is there something else I can do?" So, she's a good example of somebody who may really benefit from progesterone. I used natural progesterone with her, and I gave it to her every night. I gave her about a 100 mg. Dr. Elizabeth Boham (28:04): At some point, we went up to 150 milligrams every night and it really helped. It really helped her sleep. She started getting better sleep. She was calmer. It helped her with that transition through that perimenopausal years. Like you said, we don't necessarily keep people on hormones for long, long periods of time. It's just to help with that transition. That's a situation where I think hormones can be helpful. Dr. Mark Hyman(28:29): Yeah. Tell us about the second case. Dr. Elizabeth Boham (28:31): Yeah. So, she was interesting. So, she was a woman, she was like 53. She was already post-menopausal. So, she had gone through menopause. She hadn't had a period for a year and a half, two years. So, she was officially post-menopausal. Definitely having hot flashes, definitely still having night sweats, but she was a thin woman and she had a strong family history of osteoporosis. Her mom broke her hip in her 70s and was also a thin woman. So, she was really worried about her bone density, frustrated with these hot flashes and just wondered if hormone therapy would be the best thing for her. She didn't have a strong family history of breast cancer at all. Dr. Elizabeth Boham (29:16): So, we had a long conversation about everything she can do for her bone density. We worked on her nutrition, we worked on her gut, we made sure she was getting enough vitamin D and K and doing exercise and resistance exercise to help build strong bones and jumping and strength training. But, her bone density didn't improve enough. So, we did start her on some of the drops of estrogen progesterone testosterone that she used transdermally. Dr. Mark Hyman(29:47): The testosterone can help bone density a lot too. Dr. Elizabeth Boham (29:49): Exactly. Exactly. I also gave her ... she was struggling with vaginal dryness. So, I gave her some vaginal estrogen as well, which can be helpful. For vaginal dryness, we can use vaginal estrogen. We can use vaginal DHEA. Actually, it can be really helpful. Of course, there's all the different vaginal lubricants and moisturizers, but I always encourage people to get really natural products that don't have added parabens in it or aren't petroleum based. Dr. Mark Hyman(30:14): Like coconut oil. Dr. Elizabeth Boham (30:15): Coconut oil is great. Exactly. So, there's a lot of things we can do to help a woman. Dr. Mark Hyman(30:18): How'd she do? Dr. Elizabeth Boham (30:19): She did really well. Her bone density stabilized. Actually, we saw a slight improvement one year. She was really good with her strength training program, which I think is key for bone density and- Dr. Mark Hyman(30:33): Plus for aging in general. Dr. Elizabeth Boham (30:34): Oh yes. For aging in general. The most important thing we can be doing, right? Dr. Mark Hyman(30:37): Yeah. I'm like 60 now. I hated strength training my whole life because every time I did it my muscles hurt, and I'm like, "This is so painful. I don't want to do it anymore." I never worked through that stage. Now, I've gotten on onto it and it's the most amazing thing. I see the changes happening so fast in my body. I'm like, "Wow, this is my best my body's been my whole life and I'm like 60." I'm like, "Wow, how did that happen?" Dr. Elizabeth Boham (30:58): It really is the best thing we can all be doing. Dr. Mark Hyman(30:58): Yeah. It's so great. So Liz, thank you so much for sharing your wisdom about hormones, hormone replacement, and how do we navigate this very confusing world. For those of you listening, if you found yourself going, "Oh, that's me. Oh yeah, I had that." or "I'm struggling." or "I have these questions." Well, maybe you should check out the UltraWellness Center. We are here in Lenox, Massachusetts, but we're doing all virtual visits too now. You can come if you like, but we'll certainly see you virtually on Zoom. All you have to do is go to UltraWellness Center to come, learn more about our practice, and we'd love to see you and help you out. Dr. Mark Hyman(31:32): For those listening, if you love this podcast, please share with your friends and family on social media, leave a comment. Tell us about your struggles with hormones, maybe what you've done to help yourself and subscribe wherever you get your podcast. We'll see you next time on The Doctor's Farmacy. Dr. Elizabeth Boham (31:47): Thank you, Mark.