Is Hormone Replacement Therapy Safe? The Science Behind HRT and Breast Cancer Risk with Dr. Maria Sophocles

Are you feeling uncertain about what’s happening to your body during perimenopause and menopause? Are you unsure of whom to trust regarding hormone therapy?

In this episode, I talk with Dr. Maria Sophocles, a nationally recognized menopause specialist, OBGYN, and founder of Women’s Healthcare of Princeton. With nearly 30 years of experience and a deep passion for women's health in midlife, Dr. Sophocles helps clarify the confusion surrounding the latest in menopause research. 

We discuss why many women miss out on the powerful benefits of hormone replacement therapy due to outdated information. You’ll learn about the latest science and treatments for menopause and perimenopause, along with the benefits and risks of hormone replacement therapy (HRT).

You’ll learn:

• How the 2002 Women’s Health Initiative (WHI) study misinformed the public and created widespread fear, and how recent research has dispelled these misconceptions.
• Why many women are being told by their doctors to “tough it out”.
• What the research indicates about HRT and breast cancer risk.
• How estrogen therapy supports your brain, heart, and bones
• The role of vaginal estrogen minimizing urinary tract infections (UTIs) and enhancing sexual comfort.
• Why it’s not too late to start the treatment of menopause, even if you’re in your 60s or 70s.
• Tips on finding a trained menopause specialist, including options for virtual care.
• How HRTs can improve sexual wellness in midlife and beyond, helping to close the bedroom gap.

If you’re in perimenopause or menopause, this conversation is essential for providing the support, insight, and clarity you need. 

Grab your earbuds and tune in to make your second act more intimate and pleasurable!  

Much love,
Laurie

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Dr. Maria Sophocles

TED Talk: What happens to sex in midlife? A look at the "bedroom gap"

Instagram: @mariasophoclesmd

Website: mariasophoclesmd.com

Other menopause

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DISCLAIMER: THE COMMENTARY AND OPINIONS AVAILABLE ON THIS PODCAST ARE FOR INFORMATIONAL AND ENTERTAINMENT PURPOSES ONLY AND NOT FOR THE PURPOSE OF PROVIDING LEGAL, MEDICAL OR PROFESSIONAL ADVICE. YOU SHOULD CONTACT A LICENSED THERAPIST IF YOU ARE EXPERIENCING SUICIDAL THOUGHTS. YOU SHOULD CONTACT AN ATTORNEY IN YOUR STATE TO OBTAIN LEGAL ADVICE. YOU SHOULD CONTACT A LICENSED MEDICAL PROFESSIONAL WITH RESPECT TO ANY MEDICAL ISSUE OR PROBLEM.

Transcript

Laurie James: 0:02

Hey there. It's Lori. And before we get started on today's must listen podcast, I wanted to share a couple of things with you. First, for all my local listeners, I am having an in person workshop that I'll be hosting on Saturday, June 14. I'm calling it an embodiment workshop, as you know, if you've listened to this podcast for a while, we don't get to midlife without experiencing some type of traumatic experience, and if we don't slow down to notice what's showing up in our bodies and our nervous system, it can wreak havoc on our lives like it did mine when I landed in the hospital. So when we can learn to slowly release it, then we can move towards our more desired life. If this interests you, I'd love to have you join me and please click the link in my bio before we dive into this podcast with one of the top 10 OBGYN who specializes in menopause, I wanted to remind you that this podcast is for entertainment and information only. This is not medical advice, so please consult your doctor before making any decisions when it comes to hormone replacement, female wellness and your health. So enjoy this enlightening conversation with Dr Maria Sophocles. Welcome to Confessions of a free bird podcast. I'm your host. Lori James, a mother, divorcee, recovering caregiver, the author of sandwiched A Memoir of holding on and letting go, a therapy junkie, relationship coach, somatic healer and now podcaster, I'm a free spirit, and here to lift you up on this podcast, I'll share soulful confessions and empowering conversations with influential expert so you can learn to spread your wings and make the most of your second half. So pop in those earbuds, turn up the volume, and let's get inspired, because my mission is to help you create your most joyful, Purpose Driven Life, one confession at a time. Okay, free birds. This is an episode that is a must listen if you are female, anywhere from the range of 35 to 70 plus. So grab your headphones, and this may be a little bit longer than normal, but it will be worth your time today, I have the pleasure of talking to Dr Maria sofolis. She is a leader in women's health for nearly 30 years, specializing in menopause management and female sexual health. She founded women's health of Princeton, a progressive gynecology practice, and has been a visiting professor and NIH researcher in Switzerland, a Board Certified OBGYN and menopause society certified practitioner. She has pioneered innovative treatments, including CO two laser therapy for vaginal atrophy. She serves as CMO of Embr labs, Director of women's health services for Curia health, and is an advocate for women's health policy. Dr Sophocles is also an author and frequent media contributor of women's health topics. Her TED Talk, which is a must listen, what happens to sex in midlife, has garnered over 1.2 million views in total. And her forthcoming book, a bedroom gap, will be released later this year in 2025 and she has already offered to come back and talk more about that book then she's currently working on a documentary also about sex menopause and gender equality called hot. And I have to confess, I asked some of my listeners and also a couple of friends questions that they had, and hopefully your questions will be answered as well. So thank you so much for being here, and can you start with telling us a little about your passion around women's health and women having sex in midlife.

Dr. Maria Sophocles: 4:33

Sure, I trained in a very traditional way to be a doctor, and I learned how to deliver babies and do surgery, and I went out into private practice thinking I was well equipped, only to find out that I was completely woefully under prepared to understand and treat menopause. I didn't understand when women told me they had frozen shoulder and palpitations and they were losing their. Hair, and they were moody and crying all the time. I thought, Oh, I guess they need an orthopedic surgeon, a neurologist, a psychiatrist, a hair specialist. I had no clue. And this is stunning to me that most doctors, even most OB GYN, still do not have training in menopause. So three quarters of women who go to see a doctor for help with menopause leave without answers because our medical education really, really failed us. It left that out of the equation. So I was in private practice doing a terrible job of helping these women, and so I made myself kind of find menopause leaders in the country and train under them and learn from them. And that helped me to, in turn, start a practice in Princeton, New Jersey, called women's health care of Princeton that was back in 2008 and we now have served women from all over the country, specifically in midlife, within menopausal issues, I found that the sexual stuff was still really under the radar. And this, again, was because sexual health is not really valued as part of human health, so it's not taught in medical school. And patients didn't really have a lot of knowledge either about what was happening. They would come in and say, I'm sure it's just me, but something's wrong with me. Sex hurts. It's dry. I have no libido. I don't want to tell anyone, not even my partner. I'm so embarrassed. And you know, I think socio culturally, we are okay thinking about sex as something for male pleasure, and we're okay thinking about teenage boys masturbating. We're okay understanding that men watch porn, but we sort of shove women off to the side and just figure we'll figure sex out for ourselves or something. So I'd really love to disrupt that whole narrative, and that's the point of the TED talk in the book in the documentary. But before all that, I really spent many years just teaching women, one on one about menopause, and I thought today that would be a great place to start, just to debunk some of the myths. There's really a lot of misinformation. Lori, there is

Laurie James: 7:18

so much misinformation, and that was very clear when I got all these questions that came in. And so thank you for taking time out of your busy day, because you have a lot going on to answer and to debunk these questions. And one of the things I want to also have you just touch on before we get into some of the questions that we talked about before we hit record was, what's the percentage of women that are on hrts, on average, that are either perimenopause or in menopause? Yeah,

Dr. Maria Sophocles: 7:56

so it's gone up in the last few years thanks to influencers, mostly which we're grateful for. But a few years ago, it was 1.8% so 98.2% of women who could benefit from HRT were not using it, and that's because of these myths that are now 20 years old and have been totally disproven with scientific study, but even many doctors just haven't learned that or are afraid. Don't forget, we live in a society where people get sued. So if a doctor's not sure, they're just going to say, you don't need that, don't do that, right,

Laurie James: 8:36

right? Rather say no, then get sued if they're wrong, yeah, and you can't blame them. Well, I blame

Dr. Maria Sophocles: 8:43

them for not keeping current. I think you should keep current if you're a doctor. Thank you.

Laurie James: 8:48

Thank you for that. So can you start for our listeners and for me, helping us understand what the old research was and then what the new research is showing when it comes to hrts Overall, and then we can get into more specifics, sure.

Dr. Maria Sophocles: 9:10

So in 2002 The New York Times broke a story the author of that paper was Gina colada, a famous and wonderful New York Times reporter who's still a reporter. She's lives on my street. She's a writer. So really smart woman, but the information she was handed unknowingly was data from a study that was done incorrectly. That study was called the WH I Women's Health Initiative, and it developed to look at what happens with hormone therapy and heart disease. If we give women hormone therapy, do they have protection against heart disease, or do they get more heart disease? What happens? They also decided to look at its relationship to both. Breast cancer and to some other things. Within that study, a small, tiny, tiny subset looked like the women were having a slightly higher risk of breast cancer, so they stopped the study. It didn't meet statistical significance. So it wasn't truly showing it. It was maybe hinting at it. And as one very famous author has told me, because he wrote a book called estrogen matters, showing how this was wrong. He said, Maria, if I'm in the NCAA championships and I'm a basketball team and I throw a basket at the rim at the buzzer and it doesn't go in, but it almost goes in. We don't count it. We do not count those two points. And this data showed maybe kind of almost a slight increased risk, but not significant. So it didn't go in the basket, didn't go in the basket, wasn't enough to actually be really abnormal. Thank God, thank God. But the media was given information from the researchers that this causes breast cancer, and they went crazy with it, and that was really a shame, because it damaged the benefit that so many women could have gotten over the last 20 years, reduced osteoporosis, reduced heart disease, reduced cancers. So it showed a slight, maybe increased risk in breast cancer in one small subset, in women who had only estrogen, like have no uterus. If you have no uterus, you just get estrogen. It did not it showed a decrease in cancer in women who had a uterus. It showed potentially slight increase in breast cancer. Now that's scary, so 23 years later, we've done a lot of studies to see if that's true or not. Turns out it's not true. Turns out those studies that have been done over the last 23 years have shown just the opposite, that women who get estrogen and progesterone have about a 20 something percent reduction in all cause mortality, and women who take only the estrogen part, they're even healthier, they have up to a 40% reduction in cancer. So not only does it not cause cancer. It actually reduces cancer risk. You are less likely to get cancer or die of cancer taking HRT, that's a big difference. That

Laurie James: 12:30

is a huge difference now, and when you talk about cancer, is that just breast cancer and ovarian cancer, so the female related cancers, or is it all types of cancer? It's

Dr. Maria Sophocles: 12:40

not every cancer they couldn't have studied, all right, right, right? Nobody has the money to study skin cancer and eye cancer, whatever, but breast and ovarian cancer for sure. And then here's a surprise, colon cancer. You have about a 40% reduction in colon cancer if you take HRT. That's massive. That's not small, that's not almost missed the basket, that's in the basket, that's

Laurie James: 13:05

yes, that's the slam dunk, in my opinion. And

Dr. Maria Sophocles: 13:09

colon cancer is common. Sadly, I'm sorry to say, breast cancer and ovarian cancer scare us, but colon cancer is very common,

Laurie James: 13:17

yes, and why is that? Well, the study was

Dr. Maria Sophocles: 13:21

done on much older women who were at higher risk for cancer, because remember, the number one risk of breast cancer is age. So if I do a study on 40 year old women, and you do a study on 90 year old women, my study might show different things than your study, because 90 year old women have a much higher rate of breast cancer than 40 year old women, right?

Laurie James: 13:46

But also, don't we have hormone receptors all over our body as women,

Dr. Maria Sophocles: 13:52

the eyes, the mouth, the hair, the skin, the vulva, everywhere, the bladder, the bones, the coronary arteries, so the brain is covered in parts of the brain that that rely on estrogen. This is why dementia is lower in women before menopause, and then rises. This is why heart disease is lower in women than men until menopause, and then when we lose the estrogen, it catches up very rapidly. So think of it this way. Here's a really interesting way to think of it. If estrogen caused breast cancer, then how come we don't have a ton of breast cancer during pregnancy when we have sky high estrogen, if we have sky high estrogen for nine months and it causes pregnancy, then pregnant, it causes breast cancer, then pregnancy should be Wow, big time, breast cancer time. But it's not. It's not so it just it actually doesn't make sense. So that's the first myth that I want to bust. Is that HRT causes cancer. It does not. The second myth is really that HRT causes. Is heart disease or strokes? It does not in fact, as I just said, we see lower risk of heart failure, stroke and heart disease in women who get on HRT and stay on HRT. That's important, because that's the number one killer of women, more than any cancer, is heart disease. If you and I were at Las Vegas gambling, and we said, Let's gamble on what most of the women in this casino are gonna die from. It would be heart disease, okay? And that's huge, but it's a silent killer, so women aren't as afraid of it. But remember what I said? There are actually estrogen receptors on the coronary arteries, so when we lose estrogen, those plaques begin to build more quickly, and you can't feel it or see it, but it's happening same with osteoporosis. When we go through menopause, the first five years after our period stop, is the five years of our lives with the most rapid loss of bone strength,

Laurie James: 15:59

Yep, yeah, that's when osteo when my osteopenia showed up. That's first five years after I hit menopause. That's

Dr. Maria Sophocles: 16:07

right, because we sapped the estrogen away, you know, and then now

Laurie James: 16:11

it's been, you know, pretty stable, but I am on hrts. I do do weights, and, you know, I walk a lot.

Dr. Maria Sophocles: 16:22

Yeah, it's not only HRT. Yeah, it's a strength training. There's so much we could talk about in terms of health and and by the way, HRT isn't a magic bullet. It's not going to get rid of wrinkles, it's not going to make your legs longer, it's not going to prevent cancer. I wish it. Oh, damn. I know someone will get the Nobel prize if they can find that. But it doesn't do all that, but it puts the brakes on the development of osteoporosis, and it puts the brakes on the degradation of some of the neural pathways that lead to dementia and some of the heart disease. So that's all you're doing, is slowing down things to give you know what's cool about that is we live longer now, when women remember 200 years ago, women didn't live past menopause, so it didn't really matter. But now we live a third of our life after menopause, and I don't know about you, but I want to live that third as healthy as I can, for as long as I can, exactly how long I live, but I want to be healthy for as much of it as I can,

Laurie James: 17:24

exactly, especially I oversaw my parents care for 14 and a half years, and one of the things that happened to my mom is she had a hysterectomy, and she was put on high dose of hormone replacement and

Dr. Maria Sophocles: 17:40

probably oral, which we know oral is not safe compared to transdermals. It's not a myth. It's just a take home. Point is now we don't use that anymore, because oral estrogen can make the blood clot more easily, but through the skin, gel patch, mist that does not so that is much, much safer. So how you get your HRT matters? Okay? So

Laurie James: 18:05

we'll get into that. But before we get into that, question is if somebody's listening and they're like, Okay, I am going through menopause, or maybe recently started menopause, and this is peaking my interest, where does somebody start? How do they learn about what hormone replacement therapy is best for them, and then also the dosage? Because, if I'm not mistaken, there's estrogen, there's progesterone and and I think, and testosterone,

Dr. Maria Sophocles: 18:38

yeah. So first of all, there are some good websites that you can go to, and there are clinicians like myself who have robust Instagram followings where we post about this stuff. Mine is Maria Sophocles. MD, so you can go on that and see Instagram posts or podcast appearances that I've done where we talk about this.

Laurie James: 19:00

Yeah, yeah. And I'll have that her link in the show notes, your link in the show yeah.

Dr. Maria Sophocles: 19:04

And that'll be simple, simple. You can go to my friend Kelly Casperson. She has a great podcast, and she has a lot of it's called you are not broken. She has a lot of good information. You can also type in menopause.org to Google, and that'll take you to the menopause Society, the National Medical Society that we learn menopause from. And they have loads of videos and things for non clinicians to learn from. So menopause.org Now you can also find a menopause practitioner by putting in your zip code, and they list people like myself who have extra training in menopause, on

Laurie James: 19:47

menopause.org website, menopause.org.

Dr. Maria Sophocles: 19:50

Yep, and a good visit with a menopause trained clinician is really helpful. There are also startup tech companies that do menopause. Visits virtually like MIDI, M, i, d, I, which wonderful, high quality nurse practitioners who've been trained in menopause. I myself do virtual visits because I have licenses in other states.

Laurie James: 20:14

Do you have a license in California? Because I'm in California so and I have a lot of listeners here. Yeah,

Dr. Maria Sophocles: 20:19

yeah. So I do too. I have a lot of patients in California before COVID, they would just fly out to Princeton, which I always felt guilty about. And now COVID taught us all that we can do a lot through zoom, right? Yeah, yeah, just do virtual visits, and it's wonderful. The first visit is like two hours, and we just cover everything. It's like a two hour get to know you session, and we do whole life kind of planning, nutrition, exercise, all that stuff. It's really been great. It's a great way for me to care for people far away, but still give really, really good care. And you're right. Lori, there's estrogen, progesterone, testosterone, all three are made in the ovaries. The estrogen is what we really need for our bones, our heart and our brain, the progesterone you need if you have a uterus. And that's because if we just give estrogen in the uterus, it's like putting fertilizer on a lawn, but the progesterone, we don't want your uterus to grow tissue anymore, so the progesterone inhibits that. So progesterone is sort of protecting the uterus from too much estrogen, and the progesterone is just a pill at bedtime. It's very easy. It also helps with sleep. So it's nice if sleep is sort of disrupted, the estrogen comes in a patch that's five different doses. It comes in gels that are different doses. And you're right. It's important to have a visit with someone like me, to think through what's a good dose and then to follow up. I usually follow up every six weeks for a while, until we get the right dose. Yeah,

Laurie James: 21:51

cause, I'm guessing it takes a little time to get that balance well, to figure

Dr. Maria Sophocles: 21:56

out what's the right dose for you. Right? If you call me six weeks later and say, I'm feeling better, but my breasts are super tender and swollen. Well, I think maybe we're a little too high. It's less blood work than you think. People always say, I better get the right blood work. But there's two reasons to take HRT. The first is symptom control having hot flashes or joint pain or palpitations, the second is not having any symptoms. I passed that or I never had it. But I want my bones, heart and brain, to be strong. So I don't care whether you take it for the first, the second or both, but it will effectively help both reasons beautiful.

Laurie James: 22:39

So one of the questions that came in was, so some of my listeners are older and have been in menopause for a while and have not taken any hrts, and they have been instructed by their doctors, oh, you're past that. You don't need hrts. So

Dr. Maria Sophocles: 22:59

that's old knowledge. So 20 years ago, when we started to realize that study was incorrect and we should tiptoe back to HRT, all doctors were a little bit afraid, like, what if we just let the cat out of the barn and then suddenly find out 20 years from now it is bad? So we said, why don't we just let people do it for five years? And then we said, well, that's safe. Why don't we let them do it for 10 years? We found out that's safe, and now we've looked at women who've been on HRT for decades, and you know what? They're safe. They don't have more cancer, they don't have recurrence of their breast cancer, even if they had breast cancer before. They don't they have stronger bones, clearer minds and cleaner arteries. So the thinking today is, there's no benefit to this. I can only do it five years or so. We keep people on it long term. And I tell people, think of it like seat belts or sun block. You never say, Well, I'm 68 now. I don't need seat belts anymore. I passed the period of time when it's safe for me. Nobody would say that. Same with sunblock, same with HRT, the longer you're on it, the longer your bones are getting protected, the longer your bladder is staying healthy. Because, remember, urinary tract infections in women are a real cause for hospitalization and HRT could go to the bladder too, right?

Laurie James: 24:25

I dealt with that with my mom. It was awful, and then she would get sepsis, because it was over bloodstream and I mean, and watching her in so much pain, it was really hard to

Dr. Maria Sophocles: 24:38

watch, and it was unnecessary, because we have vaginal estrogen now. Vaginal estrogen has been around since 1946 it's not actually that new, but again, it's very underused and it's very safe. If you look at my TED talk, and you could put that in the notes, yes,

Laurie James: 24:56

I definitely will, and it is a must listen, because it's not only. Definitely very informative. It is entertaining to definitely have that beautiful balance of the perfect TED Talk. Thank

Dr. Maria Sophocles: 25:10

you. Well, the point is that I want people to know that vaginal estrogen is you know how I talked about how crazy safe systemic estrogen is, vaginal estrogen is even safer because it doesn't go to the uterus, the breast, anywhere. It just helps the bladder and vagina. So when women have urinary tract infections and we give them vaginal estrogen, those urinary tract infections decrease, and that's as you know, from mom, that can save them. Hospitalizations, saves our healthcare system 1000s of dollars, saves pain and suffering so

Laurie James: 25:46

so if somebody comes to you, or a doctor who's who's trained and has more training in menopause, the doctor will run tests to just figure out what levels, and then you play with it a little bit.

Dr. Maria Sophocles: 26:02

Not so much. That's what people think. They think it's all about levels. But the truth is, if you come to me and you're 48 and you because we're going to do 4858 and 68 if you're 48 and you say, I'm still having periods, but Oh, having hot flashes. I'm moody. I can't remember where my keys are. I have anxiety. Something's wrong with me. You're in perimenopause the decade or so before period stop, and that can be miserable. You can have, yes, you can have HRT you can have it. Then we don't even need a lot of levels, because the levels are actually going crazy. They're like this. They're fluctuating up and down right throughout your month. They fluctuate throughout the month, but in perimenopause, they even fluctuate within the month. So levels are almost useless, like it might be 30 today and 70 tomorrow. So which is it? The answer is both. So the numbers don't help us. We treat the symptoms, treat the same Okay, once you're menopausal, we don't really need them, because they're all down near zero. What we use the levels for is testosterone, because we don't have standardized testosterone in this country for women. So if I make up some testosterone for you at a compounding pharmacy, I have to check your testosterone levels to make sure they're in a safe range the estrogen and progesterone. It's not that we don't need blood levels at all, but we don't need to keep repeating them. We can give you the patch and the little pill of test of progesterone. We can check to make sure you're in a range like you were before menopause. But almost everybody is because these are so standardized. You know, we don't need fancy stuff. We need stuff made by big pharmaceutical companies that's all bio identical. Now, in the old days, bio identical meant you had to go to some specialty pharmacy and get it mixed up. Not true anymore. Bioidentical, which means biologically identical, same chemical structure as what your body makes. That's all made by Pfizer and GlaxoSmithKline and bear, all bioidentical. Now

Laurie James: 28:15

everything, Oh, interesting. I did not know that.

Dr. Maria Sophocles: 28:19

Now, the one made from horse's urine is not bioidentical, and that's still on the market. And that works. I don't want to say it doesn't work. It does work, whether it's the vaginal cream or the pill. It works. But we don't really use oral estrogen anymore, so there's not really a need to prescribe that anymore. So everything you will be prescribed if you're getting it from a good clinician who knows their stuff, will be at your pharmacy. Pick it up at your pharmacy, made by big pharma, FDA approved, standardized dosing and bioidentical it should all say estradiol on it. We want to put E, S, T, R, A, D, i, o, l, that's what you should be taking

Laurie James: 29:00

Right, right? Okay, so we've covered the 48 year old. The 58 What about the 68 year old?

Dr. Maria Sophocles: 29:07

The 68 year old is coming in saying, I think I missed the boat. I don't have any hot flashes anymore. I don't have anything anymore. Should I take anything? And the answer is, maybe, you know the answer is yes, take it if you want to protect your bones from osteoporosis, or if you want to not get UTIs as an older woman and

Laurie James: 29:29

then the brain health too, right? Or is that past at that point? No, it's

Dr. Maria Sophocles: 29:34

not past. It's always now again, not to be Debbie downer, but yes, the 68 year old missed her magic five to 10 year window, when you can do the most good, but you know you can discuss if you're that 68 year old woman with your doctor and say, Look, I know I missed the bulk of the benefit, but I know there's still some benefit, because I know if I take that estradiol, my. My bones stay healthier longer, we slow down the degradation, and I want to be an 88 year old grandma surfing with my grandkids, and that's fair. No doctor should tell you, No, I You're not allowed to have it now. The doctor may say, Well, you missed, you know, the magic window, but that's, I think that's a cop out. I think that's a cop out. And I think that's sexist. It's saying you're too old. Let's just let you hang out to dry and shrivel up. And, you know, we have 68 year olds founding companies and running nonprofits and and winning Golden Globe and Academy Awards. And why should we say you're too old to maintain your health. I mean, we don't say that to men, do we? I mean, I don't think we're giving them Viagra In fact, you know, but

Laurie James: 30:50

then we're all shriveled up and don't want to have sex. Well, we will

Dr. Maria Sophocles: 30:54

want to have sex if we can have some vaginal estrogen to regenerate the collagen and the blood vessels. And we will want to have sex if we can use a little bit of compounded testosterone through the skin that juices up our interest a little bit. And we will want to have sex if society says it's okay, it's not shameful. Yeah.

Laurie James: 31:14

And those are all really wonderful points and, and yes, I am in agreement with all those but what do you want to say to the skeptical listener that might be saying, Oh, you're just pushing your products or your business, they're

Dr. Maria Sophocles: 31:29

not mine. I don't make a penny off of them. They're not mine. I get to see the women who take it and the women who don't. So I get to see the women who've not used it and have UTIs once a month and go to the hospital or who have fractures over and over, and then are in hospital for six weeks in traction. I get to see the women who suffer with hot flashes, night sweats, mood changes because their aunt told them I got breast cancer while I was on HRT, it must be the breast cancer. Well, that's just not true. It wasn't the breast cancer, but that Aunt or her doctor may have linked it incorrectly. So be careful where you get your information. Everybody has a relative who's happy to tell them that they knew someone who got breast cancer while HRT, that's fine. People do get it on HRT, they also get it off HRT. One does not cause the other, and it's really important, that's what I would say. Be very careful about knowing someone who got breast cancer while they were on HRT. That doesn't mean A caused B. It just doesn't. It

Laurie James: 32:36

means that maybe there was, there wasn't a link, but there just happened to happen at the same time, that's

Dr. Maria Sophocles: 32:43

right, that person was going to get that breast cancer anyway. Now the one thing HRT can do that's bad is if you get a type of breast cancer that has estrogen receptors, and you're on HRT, you can make that cancer grow more. But why would you deprive yourself of all the benefits, we just said, just waiting for yourself to get breast cancer? Because you may never get breast cancer, and you may never have the type that is hormone sensitive, and if you get that type, you're going to be taken off the HRT immediately. That's how it works. So

Laurie James: 33:18

if somebody has high risk of ovarian breast cancer, maybe not necessarily, Broca, and they've had their ovaries removed. They can, I think you said this earlier, they can still take hrts. It just has to be estrogen, not progesterone. They don't

Dr. Maria Sophocles: 33:38

need the uterus is out. They don't need the progesterone. Some people have the uterus out and leave the ovaries in. But it's a longer story. I'm trying to think of any other myth. You know, there's other good myths about I know that HRT and birth control pills have the same risk profile, because everybody knows that birth control pills can increase the risk of blood clots, and you can gain weight on them, and the dose of birth control pills is much, much higher than menopausal HRT, so you don't have that same weight gain risk. In fact, women on HRT sleep better and have more energy, so they tend to be more active, so they tends to not put weight on you like a birth control pill. Can same with blood clots. We don't give oral HRT anymore. We give it through the skin so it doesn't affect the clot ability of the blood so you don't get the risk of blood clots like you get from a birth control pill.

Laurie James: 34:38

So I actually have a friend who has the factor five gene, yes, and so she has been told she can't take hrts Because of that, she

Dr. Maria Sophocles: 34:47

can't take oral estrogen. She can take through the skin. I have many, many patients who have factor five Leiden, but they have to do it as a patch or gel. They just can't take oral Thank. Do even the oral progesterone could have a slight increased risk in clotting, so she may want to get her progesterone a different way too.

Laurie James: 35:08

Also, there's been a lot of changes in how often we should get a Pap smear, how often we should get mammograms. What is your recommendation on that as well for women and their health? And maybe that's different at different ages. So well, it's

Dr. Maria Sophocles: 35:23

very standardized now. So there are national standards for this. Pap smears are different now. They used to be just getting cells, and now we do DNA analysis for the virus that causes cancer of the cervix. So it's a more sophisticated test now, and it's more advanced and predictive. So we only do pap smears every three to five years. You still want to come into an OB GYN and get an exam every year so that your breast can be examined and the ovaries can be felt. But the collection of the pap smears only every three to five years, and it's only up to age 65 and then we don't do paps anymore, and that's because good studies showed that after 65 if you haven't developed abnormal cells on your Pap smear, you have almost a 0% chance of ever getting cervical cancer. So it just became not cost effective to be doing pap smears on older women. Cost effective because they were always negative. You know? They were always normal. So we were wasting money. Mammograms should be every year from age 50 and up, every year, but if you have risks, for example, if you had a mother or a sister who had breast cancer under the age of 50, then we start your mammograms 10 years before whatever age. So if your mom was diagnosed at 45 with breast cancer, we start your mammograms at 35 so for most of us, mammograms start at age 40, and they're every year for 40 Thank

Laurie James: 37:01

you. Thank you. Thank you for all this wonderful, wonderful information. I think that you've answered so many of the questions that I had already. I think this has been a wealth of information for me, and I'm so excited you've already offered to come back and share more about sex in midlife with your book that's coming out towards the end of the year, which is called the bedroom gap. As we come to a close, is there a confession? Yeah,

Dr. Maria Sophocles: 37:35

the confession is more an I guess it's an observation, but it was a surprise to me, again, I'm showing my ignorance. When I finished training, and I had some assumptions of my own about sex and that couples really probably just fade off into the sunset and don't enjoy it or do it anymore. And as I became a sexual medicine specialist and started seeing people of all ages with sexual issues. I saw also couples enjoying tremendously wonderful sex in midlife and beyond. And I think this is for a number of reasons. I think they don't have to worry about birth control or getting pregnant unintentionally. They don't have to worry about kids in the house or anything like that. And they learn, I think, the beauty of of intimacy. They de emphasize orgasm. They de emphasize penis and vagina as the only definition of sex. And they create for themselves their own version of sex and in a long term or loving partnership that can ultimately just be so gratifying. I have a little couple. She's 96 he's 94 for their checks. You know, he comes with her every year. They actually come for extra ones. I think they they don't want to wait around too long, and they're constantly telling me how much they love having sex with each other, and, oh, I think it can be a beautiful facet of a relationship in midlife and beyond. And I think at our next, next time we chat, we'll talk about what that means, like, what is that, and how do you have that? So that's kind of my confession.

Laurie James: 39:24

I'm so excited to dive into that conversation, and coming from one of the top 10 women who are in this world of women's health, and with your new book, I'm sure you are a wealth of information. So Maria, thank you so much for being here. How can people find you? I'll have all this in the show notes. But if somebody wants to jump on and make sure that they get on your Instagram or hop on your website, how can they find you? Yeah,

Dr. Maria Sophocles: 39:53

Instagram is, is Maria Sophocles, MD, and and there's always educational posts. Posts there. My Instagram is very education focused, and then my website is Maria Sophocles, md.com, and there's tabs for the book and the documentary and how to be a patient. If you click patients, you can see how to be a virtual patient. And, yeah, I think that's the easiest way. And if they Google TED Talk Maria Sophocles, they'll have fun with the TED Talk. So thank you, Lori, so much for having me. I love the title of your podcast. I love what you're doing, and I just love how you're touching people. Yeah, great, ditto.

Laurie James: 40:32

Thank you for all the wonderful work you're doing in the world, too. All right,

Dr. Maria Sophocles: 40:35

my pleasure. Till next time.

Laurie James: 40:37

Yes, till next time. Thank you for listening to this episode of Confessions of a free bird. I'm grateful to be in your ears and hearts. If you're interested in becoming a free bird, I'd love to support you. Please check out my website at Laurie james.com to learn how we can work together, or to sign up for my newsletter, so you can receive tips on how to date and relationship differently and ultimately, find more freedom and joy in your life. If you found this podcast helpful, please follow or subscribe, rate and review and share it with friends so they can find more freedom in their second or third act also until next time you.