Latest / Clearly Hormonal / Hormone Therapy and Breast Cancer: What the WHI Really Found

Transcript

Hormone Therapy and Breast Cancer: What the WHI Really Found · Clearly Hormonal

• 0:01
  Dr. Komal Patil-Sisodia: Welcome to Clearly Hormonal, the podcast where we stop googling our symptoms at midnight and actually start understanding what's going on in our bodies.
• 0:09
  Dr. Komal Patil-Sisodia: I'm Dr.
• 0:10
  Dr. Komal Patil-Sisodia: Komal Patil-Sisodia, an endocrinologist, internist, obesity medicine specialist, and a Menopause Society certified practitioner, which is really just a whole lot of words to say hormones are kind of my jam.
• 0:21
  Dr. Komal Patil-Sisodia: I've spent 17 years watching women try to navigate their hormonal health without ever having been taught the language for what's happening in their own bodies, and then meeting clinicians who want nothing more than to help them figure it out, but are up against 10-minute appointments and a system that just wasn't built for it.
• 0:37
  Dr. Komal Patil-Sisodia: This podcast is my answer to that gap.
• 0:40
  Dr. Komal Patil-Sisodia: We'll cover menopause, metabolism, hormones, and everything in between with real evidence, not trends, and without the overwhelm.
• 0:48
  Dr. Komal Patil-Sisodia: A quick disclaimer: I'm a physician, but this is education, not personalized medical advice.
• 0:53
  Dr. Komal Patil-Sisodia: Take what resonates and discuss it with your own healthcare team.
• 0:56
  Dr. Komal Patil-Sisodia: Now, let's get into it and talk about what's clearly hormonal and what's not.
• 1:04
  Dr. Komal Patil-Sisodia: If you're a woman in midlife, there is a good chance one sentence has shaped how you think about hormone therapy.
• 1:10
  Dr. Komal Patil-Sisodia: It goes like this: hormones can cause breast cancer.
• 1:14
  Dr. Komal Patil-Sisodia: Maybe a friend said it over coffee.
• 1:16
  Dr. Komal Patil-Sisodia: Maybe a doctor mentioned it years ago.
• 1:19
  Dr. Komal Patil-Sisodia: Maybe it's just something you picked up along the way, the way we all pick up health rules we've never really checked.
• 1:25
  Dr. Komal Patil-Sisodia: I get it.
• 1:26
  Dr. Komal Patil-Sisodia: I've heard that sentence in my office more times than I can count, and I've seen how heavy it feels.
• 1:32
  Dr. Komal Patil-Sisodia: A woman can be up all night with night sweats, exhaustion, and feeling foggy, and still say,"I just can't risk it." Today, I wanna take that sentence apart gently and honestly.
• 1:46
  Dr. Komal Patil-Sisodia: I'm not here to tell you to take hormones.
• 1:49
  Dr. Komal Patil-Sisodia: I'm not here to tell you to avoid them.
• 1:51
  Dr. Komal Patil-Sisodia: I want you to see the data for what it really shows so that fear isn't the only thing that's m- helping you make your decisions.
• 1:59
  Dr. Komal Patil-Sisodia: I'm Dr.
• 1:59
  Dr. Komal Patil-Sisodia: Komal Patil-Sisodia, and welcome back to Clearly Hormonal.
• 2:02
  Dr. Komal Patil-Sisodia: This is episode three of our Menopause Awareness Month series, and here's something I love about the timing.
• 2:08
  Dr. Komal Patil-Sisodia: October is also Breast Cancer Awareness Month.
• 2:11
  Dr. Komal Patil-Sisodia: In my world, those two topics belong together because fear of breast cancer is the biggest reason women tell me they skip hormone therapy, even when they're really struggling, so this month we're talking about both.
• 2:23
  Dr. Komal Patil-Sisodia: If you're just joining us, in episode one of the Menopause Awareness Month series, we talked about why perimenopause is not a lab value.
• 2:31
  Dr. Komal Patil-Sisodia: In episode two, we talked about why your body changed.
• 2:35
  Dr. Komal Patil-Sisodia: Today, we take on the biggest worry in menopause care.
• 2:38
  Dr. Komal Patil-Sisodia: So here's my take.
• 2:40
  Dr. Komal Patil-Sisodia: Hormone therapy and breast cancer is not a yes or no question.
• 2:44
  Dr. Komal Patil-Sisodia: It's a which hormone for whom, for how long, and compared to what type of question.
• 2:50
  Dr. Komal Patil-Sisodia: When we ask it that way, the fear gets smaller and the real risks get clearer.
• 2:54
  Dr. Komal Patil-Sisodia: So let's walk through it together.
• 2:56
  Dr. Komal Patil-Sisodia: And to understand where that fear comes from, we have to start with one study.
• 3:01
  Dr. Komal Patil-Sisodia: Almost everything people say about hormone therapy and breast cancer goes back to the Women's Health Initiative, or WHI.
• 3:08
  Dr. Komal Patil-Sisodia: It was a large study, and it was well-run.
• 3:11
  Dr. Komal Patil-Sisodia: In two thousand two, the combined hormone therapy part of the study was stopped early.
• 3:16
  Dr. Komal Patil-Sisodia: The headlines were loud and the prescriptions dropped fast.
• 3:19
  Dr. Komal Patil-Sisodia: If you were around then, you may remember how quickly the mood changed.
• 3:24
  Dr. Komal Patil-Sisodia: Here's what I want you to know about who and what was studied, because it's not what most of us assume.
• 3:30
  Dr. Komal Patil-Sisodia: First, the age.
• 3:31
  Dr. Komal Patil-Sisodia: The average woman in the WHI was sixty-three years old.
• 3:35
  Dr. Komal Patil-Sisodia: About two out of three were sixty or older when they started.
• 3:39
  Dr. Komal Patil-Sisodia: Most women who start hormone therapy for symptoms today are in their late forties or early fifties.
• 3:45
  Dr. Komal Patil-Sisodia: So when you hear those results, picture a group that is a decade or more older than the woman who comes to see me now for hot flashes.
• 3:53
  Dr. Komal Patil-Sisodia: Second, the hormones.
• 3:55
  Dr. Komal Patil-Sisodia: The WHI used an oral estrogen called conjugated equine estrogen, which is derived from the urine of pregnant horses.
• 4:03
  Dr. Komal Patil-Sisodia: In the combined part of the study, it was paired with a synthetic progestin called medroxyprogesterone acetate or MPA.
• 4:10
  Dr. Komal Patil-Sisodia: Third is the purpose.
• 4:12
  Dr. Komal Patil-Sisodia: The WHI was built to see if hormones could prevent diseases like heart disease, cancer, and fractures in older women.
• 4:20
  Dr. Komal Patil-Sisodia: It wasn't designed to test symptom relief in women who were newly menopausal.
• 4:25
  Dr. Komal Patil-Sisodia: So the WHI told us something important, but it didn't test the hormones, the ages, or the routes that we talk about in my clinic today.
• 4:34
  Dr. Komal Patil-Sisodia: And that matters even more once you see what the study actually found.
• 4:39
  Dr. Komal Patil-Sisodia: Here's the part that usually gets confused.
• 4:42
  Dr. Komal Patil-Sisodia: The WHI was actually two hormone therapy trials trial one was for women who still had a uterus.
• 4:48
  Dr. Komal Patil-Sisodia: They took estrogen plus the synthetic progestin or a placebo.
• 4:52
  Dr. Komal Patil-Sisodia: Trial two was for women who'd had a hysterectomy.
• 4:56
  Dr. Komal Patil-Sisodia: They took estrogen alone or a placebo.
• 4:59
  Dr. Komal Patil-Sisodia: Women without a uterus don't need a progestogen, so they could take estrogen by itself.
• 5:04
  Dr. Komal Patil-Sisodia: In twenty twenty, the twenty-year follow-up was published in JAMA, here's what it's found.
• 5:10
  Dr. Komal Patil-Sisodia: In the estrogen plus progestin trial, women had more breast cancer than women on placebo.
• 5:15
  Dr. Komal Patil-Sisodia: The rate was about twenty-eight percent higher.
• 5:18
  Dr. Komal Patil-Sisodia: In the estrogen alone trial, the result went the other way.
• 5:21
  Dr. Komal Patil-Sisodia: Women on estrogen alone had about twenty-two percent less breast cancer, and they had about forty percent fewer deaths from the breast cancer.
• 5:30
  Dr. Komal Patil-Sisodia: The same study, same estrogen, and two different answers.
• 5:33
  Dr. Komal Patil-Sisodia: Now, I want to slow down here because this next part is really important.
• 5:38
  Dr. Komal Patil-Sisodia: I'm not telling you that estrogen prevents breast cancer.
• 5:41
  Dr. Komal Patil-Sisodia: I wanna be clear about that.
• 5:43
  Dr. Komal Patil-Sisodia: That estrogen alone result goes against most of the other research we have.
• 5:47
  Dr. Komal Patil-Sisodia: Many experts, myself included, would never use it as a reason to start therapy.
• 5:51
  Dr. Komal Patil-Sisodia: I would never prescribe hormones to lower breast cancer risk.
• 5:56
  Dr. Komal Patil-Sisodia: I also want to be clear about one more detail.
• 5:58
  Dr. Komal Patil-Sisodia: In the combined therapy group, breast cancer deaths weren't clearly different from placebo at twenty years out after the trial.
• 6:05
  Dr. Komal Patil-Sisodia: But earlier, at about eleven years of follow-up, breast cancer deaths in the combined group were higher.
• 6:11
  Dr. Komal Patil-Sisodia: Over longer follow-up, that gap shrank and was no longer statistically significant, so I can't tell you that the risk was never there.
• 6:20
  Dr. Komal Patil-Sisodia: The fair summary is this: The long-term data didn't show a clear difference in breast cancer deaths, but the question isn't completely closed.
• 6:29
  Dr. Komal Patil-Sisodia: So where does that leave us?
• 6:31
  Dr. Komal Patil-Sisodia: The blanket statement,"Hormones cause breast cancer," doesn't hold up.
• 6:35
  Dr. Komal Patil-Sisodia: In the WHI, the added risk was tied to the combined therapy with a synthetic progestin.
• 6:42
  Dr. Komal Patil-Sisodia: And here's the part that the WHI couldn't answer.
• 6:45
  Dr. Komal Patil-Sisodia: It didn't test micronized progesterone, which is the bioidentical progesterone most of us use today.
• 6:51
  Dr. Komal Patil-Sisodia: It also didn't test estrogen through the skin called transdermal.
• 6:54
  Dr. Komal Patil-Sisodia: Some observational studies suggest that micronized progesterone might carry a lower risk of breast cancer than synthetic progestins, but those are not randomized controlled trials.
• 7:04
  Dr. Komal Patil-Sisodia: So I will call that promising, but not proven.
• 7:08
  Dr. Komal Patil-Sisodia: Right now, major guidelines say that the evidence isn't strong enough to pick one progestogen over another to lower breast cancer risk.
• 7:16
  Dr. Komal Patil-Sisodia: I know that's a lot of nuance, but nuance is exactly what pushed the conversation forward, and it's why the FDA took a fresh look.
• 7:25
  Dr. Komal Patil-Sisodia: You may have seen the news about the FDA and the hormone therapy labels.
• 7:29
  Dr. Komal Patil-Sisodia: If it left you confused, you're not alone.
• 7:31
  Dr. Komal Patil-Sisodia: So let me give you a timeline.
• 7:33
  Dr. Komal Patil-Sisodia: In November twenty twenty-five, the FDA announced it would remove the boxed warning on menopause hormone therapy.
• 7:39
  Dr. Komal Patil-Sisodia: That's the black box, the strongest warning that a drug label can carry.
• 7:43
  Dr. Komal Patil-Sisodia: In February twenty twenty-six, the FDA approved the first label changes for six products.
• 7:50
  Dr. Komal Patil-Sisodia: Other companies are following in small batches.
• 7:52
  Dr. Komal Patil-Sisodia: The boxed warning used to mention heart disease, stroke, breast cancer, and probable dementia.
• 7:59
  Dr. Komal Patil-Sisodia: Those statements are now off the box, or out of the black box.
• 8:03
  Dr. Komal Patil-Sisodia: But that does not mean hormone therapy is risk-free.
• 8:06
  Dr. Komal Patil-Sisodia: The safety information is still in the prescribing information.
• 8:10
  Dr. Komal Patil-Sisodia: It just isn't in the black box anymore.
• 8:13
  Dr. Komal Patil-Sisodia: The boxed warning about cancer of uterine lining stays.
• 8:17
  Dr. Komal Patil-Sisodia: If you have a uterus and take estrogen, you need a progestogen to protect it.
• 8:22
  Dr. Komal Patil-Sisodia: And breast cancer is still on the label as a reason not to use systemic hormone therapy if you have a current or past breast cancer.
• 8:30
  Dr. Komal Patil-Sisodia: So the label became more accurate and more nuanced, but it doesn't give everyone a free pass.
• 8:35
  Dr. Komal Patil-Sisodia: A label is just a headline.
• 8:36
  Dr. Komal Patil-Sisodia: What I really want you to have is the real numbers behind it.
• 8:41
  Dr. Komal Patil-Sisodia: Twenty-eight percent higher breast cancer sounds huge.
• 8:45
  Dr. Komal Patil-Sisodia: Of course it does.
• 8:46
  Dr. Komal Patil-Sisodia: But that's a relative number.
• 8:47
  Dr. Komal Patil-Sisodia: It tells you how much bigger one number is compared to another.
• 8:52
  Dr. Komal Patil-Sisodia: It doesn't tell you how big the numbers are to begin with.
• 8:54
  Dr. Komal Patil-Sisodia: So let's make it real.
• 8:56
  Dr. Komal Patil-Sisodia: In the Women's Health Initiative, women on placebo, which is no medication, had about three point six breast cancers per thousand women each year.
• 9:06
  Dr. Komal Patil-Sisodia: Women on combined therapy had about four point five.
• 9:10
  Dr. Komal Patil-Sisodia: That's less than one extra case per one thousand women per year.
• 9:15
  Dr. Komal Patil-Sisodia: It adds up to about five extra cases for every 1,000 women.
• 9:20
  Dr. Komal Patil-Sisodia: That's real, and it's not nothing.
• 9:22
  Dr. Komal Patil-Sisodia: I'm never going to wave it away.
• 9:24
  Dr. Komal Patil-Sisodia: But it's also not the picture that the statement,"Hormones cause breast cancer," puts in your mind.
• 9:29
  Dr. Komal Patil-Sisodia: Now let's put that next to some things we rarely think about.
• 9:32
  Dr. Komal Patil-Sisodia: Drinking alcohol regularly raises breast cancer risk.
• 9:36
  Dr. Komal Patil-Sisodia: Carrying extra body fat after menopause raises it.
• 9:39
  Dr. Komal Patil-Sisodia: Being inactive raises it.
• 9:41
  Dr. Komal Patil-Sisodia: These are modifiable risk factors that cancer guidelines will list as a risk for breast cancer.
• 9:47
  Dr. Komal Patil-Sisodia: For many women, those everyday risks add up to as much or more than the added risk from combined hormone therapy I'm not saying that to shame anyone.
• 9:57
  Dr. Komal Patil-Sisodia: Trust me, I'm not.
• 9:58
  Dr. Komal Patil-Sisodia: I'm saying it because we often hold hormone therapy to a stricter standard than the habits we already live with.
• 10:04
  Dr. Komal Patil-Sisodia: Risk is risk at the end of the day.
• 10:07
  Dr. Komal Patil-Sisodia: We should weigh it side by side, and we should weigh it against what treatment can do for your sleep, your hot flashes, your bones, and your quality of life.
• 10:15
  Dr. Komal Patil-Sisodia: For context, about one in eight women in the United States will be diagnosed with a breast cancer in her lifetime, and that's true whether or not she ever took a hormone.
• 10:25
  Dr. Komal Patil-Sisodia: Numbers will help, but here's the one thing about fear: It creates myths, and myths are sticky even when the facts are clear.
• 10:34
  Dr. Komal Patil-Sisodia: The old stories will stay with us.
• 10:35
  Dr. Komal Patil-Sisodia: So let's clear up four of them.
• 10:38
  Dr. Komal Patil-Sisodia: Myth number one: Hormones cause breast cancer.
• 10:42
  Dr. Komal Patil-Sisodia: The evidence here is more nuanced, and in the WHI, combined estrogen and a synthetic progestin was linked to a modest rise in diagnosis.
• 10:51
  Dr. Komal Patil-Sisodia: Estrogen alone in women who'd had a hysterectomy was not.
• 10:55
  Dr. Komal Patil-Sisodia: The type, timing, and your own risk all matter.
• 11:00
  Dr. Komal Patil-Sisodia: Myth number two: Bioidentical means safe.
• 11:04
  Dr. Komal Patil-Sisodia: This one is understandable because the word sounds so reassuring.
• 11:07
  Dr. Komal Patil-Sisodia: Bioidentical just means the molecule matches what your body makes.
• 11:12
  Dr. Komal Patil-Sisodia: It's really unfortunately evolved into a marketing term.
• 11:15
  Dr. Komal Patil-Sisodia: FDA products like estradiol patches and micronized progesterone are bioidentical They're tested, they're regulated, but compounded pellets and custom creams are not FDA approved.
• 11:28
  Dr. Komal Patil-Sisodia: Those doses can vary and don't have safety data behind them.
• 11:32
  Dr. Komal Patil-Sisodia: Natural does not automatically mean safer.
• 11:35
  Dr. Komal Patil-Sisodia: Myth number three, estrogen alone prevents breast cancer.
• 11:39
  Dr. Komal Patil-Sisodia: I understand why this one spreads, because the result is so interesting.
• 11:43
  Dr. Komal Patil-Sisodia: But it isn't a reason to start therapy, and it doesn't apply to women who need a progestogen.
• 11:48
  Dr. Komal Patil-Sisodia: Myth number four, if I take hormones, I can skip my mammogram.
• 11:55
  Dr. Komal Patil-Sisodia: This one is backwards.
• 11:57
  Dr. Komal Patil-Sisodia: Combined therapy can increase breast density and increase the chance of a callback after a mammogram.
• 12:05
  Dr. Komal Patil-Sisodia: That's a reason to stay on your current screening schedule, not to skip it.
• 12:09
  Dr. Komal Patil-Sisodia: Now, so far, we've talked a lot about hormones, but there's another piece of the puzzle, and it's one that most menopause conversations leave out.
• 12:16
  Dr. Komal Patil-Sisodia: It's your body itself.
• 12:18
  Dr. Komal Patil-Sisodia: This is where I put my obesity medicine hat on, because it's a piece I care a lot about.
• 12:24
  Dr. Komal Patil-Sisodia: After menopause, your ovaries make much less estrogen, but your body fat becomes a source of estrogen.
• 12:30
  Dr. Komal Patil-Sisodia: Fat tissue converts other hormones into estrogen.
• 12:33
  Dr. Komal Patil-Sisodia: So in a post-menopausal woman, more body fat can mean more estrogen exposure in the breast.
• 12:39
  Dr. Komal Patil-Sisodia: That's one reason excess weight after menopause is linked to a higher breast cancer risk.
• 12:45
  Dr. Komal Patil-Sisodia: Here's another interesting detail.
• 12:47
  Dr. Komal Patil-Sisodia: In a large pool analysis, that added risk from estrogen-only therapy looked smaller in heavier women.
• 12:54
  Dr. Komal Patil-Sisodia: The likely reason is that their estrogen levels were already high to begin with.
• 12:59
  Dr. Komal Patil-Sisodia: Remember what we covered in episode two?
• 13:02
  Dr. Komal Patil-Sisodia: menopause shifts fat towards the belly.
• 13:04
  Dr. Komal Patil-Sisodia: It lowers muscle, and it makes insulin resistance more likely.
• 13:08
  Dr. Komal Patil-Sisodia: If that's been your experience lately, I want you to hear this.
• 13:11
  Dr. Komal Patil-Sisodia: It's not a willpower problem, it's biology.
• 13:14
  Dr. Komal Patil-Sisodia: And it also means breast health and metabolic health aren't two separate tracks.
• 13:18
  Dr. Komal Patil-Sisodia: They're the same track.
• 13:20
  Dr. Komal Patil-Sisodia: The good news is that some of the best things you can do for breast cancer risk are the things you have real control over.
• 13:27
  Dr. Komal Patil-Sisodia: Build and protect muscle with strength training, move on most days, limit your alcohol, protect your sleep, stop smoking.
• 13:37
  Dr. Komal Patil-Sisodia: And if the weight is a concern, talk with a clinician about a plan that fits you, not a plan that shames you.
• 13:43
  Dr. Komal Patil-Sisodia: And to be clear, hormone therapy is not a weight loss treatment.
• 13:48
  Dr. Komal Patil-Sisodia: what it can do is ease things that make healthy habits harder, like night sweats, poor sleep or low energy.
• 13:55
  Dr. Komal Patil-Sisodia: That's a supporting role.
• 13:56
  Dr. Komal Patil-Sisodia: It's a real one.
• 13:58
  Dr. Komal Patil-Sisodia: So healthy habits are one way to protect yourself.
• 14:01
  Dr. Komal Patil-Sisodia: The other is catching problems early.
• 14:03
  Dr. Komal Patil-Sisodia: And since it's Breast Cancer Awareness Month, let's talk about that.
• 14:07
  Dr. Komal Patil-Sisodia: Let's start with the basics.
• 14:09
  Dr. Komal Patil-Sisodia: In twenty twenty-four, the US Preventative Services Task Force, USPSTF, recommended a mammogram every two years for women ages forty to seventy-four.
• 14:20
  Dr. Komal Patil-Sisodia: Some other groups recommend a yearly mammogram, and the right schedule for you depends on your own history and your family's.
• 14:28
  Dr. Komal Patil-Sisodia: That's a great question to bring to your clinician.
• 14:31
  Dr. Komal Patil-Sisodia: Next, I want you to know your breast density.
• 14:34
  Dr. Komal Patil-Sisodia: Since September twenty twenty-four, the FDA has required mammogram reports to tell you if your breasts are dense.
• 14:40
  Dr. Komal Patil-Sisodia: If you've gotten a letter that says"dense," I know it can be unsettling.
• 14:43
  Dr. Komal Patil-Sisodia: Dense breasts are common, and they matter for two reasons.
• 14:48
  Dr. Komal Patil-Sisodia: Dense tissue can hide cancers on mammogram, and dense tissue is linked to a higher risk on its own.
• 14:54
  Dr. Komal Patil-Sisodia: Here's the honest part.
• 14:55
  Dr. Komal Patil-Sisodia: The task force says there isn't enough evidence yet to know if extra imaging like ultrasound or MRI helps women with dense breasts and a normal mammogram.
• 15:04
  Dr. Komal Patil-Sisodia: Other expert groups see it differently, and some support extra imaging in certain cases, especially for extremely dense breasts.
• 15:13
  Dr. Komal Patil-Sisodia: Insurance coverage varies as well.
• 15:16
  Dr. Komal Patil-Sisodia: So if your report says"dense," do not panic and don't ignore it.
• 15:20
  Dr. Komal Patil-Sisodia: Ask your clinician,"Given my density, my family history, and my overall risk, what's the right plan for me?" And ask about a risk assessment.
• 15:31
  Dr. Komal Patil-Sisodia: If you haven't had one, ask if a breast cancer risk model makes sense for you, and that's especially true if you have a close relative with breast or ovarian cancer.
• 15:40
  Dr. Komal Patil-Sisodia: Now, I know some of you listening have a different story.
• 15:45
  Dr. Komal Patil-Sisodia: Maybe you've already walked through the breast cancer yourself, or maybe your risk is even very high, and I want to talk to you directly.
• 15:52
  Dr. Komal Patil-Sisodia: First, I see you.
• 15:54
  Dr. Komal Patil-Sisodia: Menopause symptoms are hard enough on their own.
• 15:56
  Dr. Komal Patil-Sisodia: They can feel even harder when you've been through thyroid cancer or when you're carrying a high risk and doing everything right.
• 16:04
  Dr. Komal Patil-Sisodia: For most women with a personal history of breast cancer, systemic hormone therapy is not recommended.
• 16:10
  Dr. Komal Patil-Sisodia: I won't sugarcoat that, but you're not out of options.
• 16:13
  Dr. Komal Patil-Sisodia: You do not have to just suffer through the symptoms.
• 16:16
  Dr. Komal Patil-Sisodia: For hot flashes and night sweats, there are non-hormonal choices.
• 16:20
  Dr. Komal Patil-Sisodia: Venlafaxine, an antidepressant, can help.
• 16:22
  Dr. Komal Patil-Sisodia: So can gabapentin.
• 16:24
  Dr. Komal Patil-Sisodia: There are also newer prescription medications that target the brain pathway behind hot flashes.
• 16:30
  Dr. Komal Patil-Sisodia: Cognitive behavioral therapy and clinical hypnosis can help too.
• 16:35
  Dr. Komal Patil-Sisodia: One caution, if you take tamoxifen, some antidepressants like paroxetine and fluoxetine can block how your body turns tamoxifen into its active form.
• 16:45
  Dr. Komal Patil-Sisodia: Researchers still debate how much this changes outcomes, but most guidelines say to avoid those two with tamoxifen, and venlafaxine is a safer choice.
• 16:55
  Dr. Komal Patil-Sisodia: Always check any new medication with your oncology team.
• 16:59
  Dr. Komal Patil-Sisodia: For vaginal dryness and painful sex, starts with a hormonal moisturizer and lubricants.
• 17:05
  Dr. Komal Patil-Sisodia: After a careful talk with their oncologist, some women may be offered very low-dose vaginal cream.
• 17:12
  Dr. Komal Patil-Sisodia: Very little of it gets into the bloodstream, but that decision should be made together case by case.
• 17:18
  Dr. Komal Patil-Sisodia: And if you carry a high-risk gene or you have a strong family history, plan with a breast cancer and menopause specialist working together.
• 17:25
  Dr. Komal Patil-Sisodia: You deserve a plan that was built all around you.
• 17:28
  Dr. Komal Patil-Sisodia: Okay, we've covered a lot of ground today, and let's bring it all home.
• 17:33
  Dr. Komal Patil-Sisodia: If you remember only three things from today, it should be these three.
• 17:38
  Dr. Komal Patil-Sisodia: Number one, hormones cause breast cancer.
• 17:41
  Dr. Komal Patil-Sisodia: That's too simple to be useful.
• 17:44
  Dr. Komal Patil-Sisodia: The type of hormone, your age, whether you have a uterus and your own risk can change that answer.
• 17:52
  Dr. Komal Patil-Sisodia: Number two, look at absolute risk, not just the scary-sounding percentage.
• 17:56
  Dr. Komal Patil-Sisodia: Then weigh it next to everyday risks like alcohol, body fat and inactivity.
• 18:02
  Dr. Komal Patil-Sisodia: And number three, whatever you choose, keep up with screening, know your breast density and build muscle.
• 18:08
  Dr. Komal Patil-Sisodia: Those protect you either way.
• 18:10
  Dr. Komal Patil-Sisodia: Thank you for spending this time with me.
• 18:12
  Dr. Komal Patil-Sisodia: And if you're thinking about hormone therapy or if fear has kept you from even asking, I hope today gave you a calmer place to start a conversation with your clinician.
• 18:23
  Dr. Komal Patil-Sisodia: You deserve to make this decision with facts, not fear Here's what's coming up next.
• 18:29
  Dr. Komal Patil-Sisodia: In episode four, we finish our Menopause Awareness Month series with a topic I think the most underestimated of all, the cardiometabolic stuff.
• 18:38
  Dr. Komal Patil-Sisodia: Heart disease is the leading cause of death in women.
• 18:41
  Dr. Komal Patil-Sisodia: What happens to your cholesterol, blood pressure, bones, and blood sugar around menopause matters just as much as breast cancer worry we talked about today.
• 18:50
  Dr. Komal Patil-Sisodia: So come back next Wednesday and bring a friend.
• 18:53
  Dr. Komal Patil-Sisodia: I'm Dr.
• 18:53
  Dr. Komal Patil-Sisodia: Komal Patil-Sisodia.
• 18:56
  Dr. Komal Patil-Sisodia: If this episode helped, please share it with someone who needs it and subscribe so you don't miss it.
• 19:01
  Dr. Komal Patil-Sisodia: This is Clearly Hormonal, and I'll see you on the next episode