Empowering Midlife Wellness with Dr. Susan Dr. Susan Hardwick-Smith

The most common killer of both men and women is heart attack, so understanding how to reduce our risk could not be more important. Since the 1980's, studies have consistently shown that menopausal hormone therapy (particularly estrogen) reduces the risk of heart disease in women. The now infamous Women's Health Initiative study surprised the medical community in 2002 by suggesting that hormone therapy increased the risk of heart attack in a small subset of women. After 22 years of gathering more data, multiple large studies have now confirmed what we previously understood, which is that estrogen has a highly beneficial effect for the heart if it's started in the first 10 years after menopause, and benefit seems to be negligible if it's started later (but not harmful). We no longer recommend taking the lowest dose for the shortest time, but rather suggest starting menopausal hormone therapy as early as possible and continuing it long term. For the great majority of patients the benefits far outweigh any potential risks.

Many people have strong opinions about compounding pharmacies, although few people know what they really are, how they are regulated and what the difference is between one type of compounding pharmacy and another. There is a perception that compounded drugs are not FDA approved, not regulated or somehow not safe or reliable. Today I'm going to explain what these pharmacies are, why we might choose to use them (or not) and why the perception that compounding is inferior or not safe is quite inaccurate.

This past two decades has brought so much confusion about menopausal hormone replacement and breast cancer risk, but we now are entering a modern time with a much better understanding of how all this works.

Today I'm going to review how this controversy ever started and what the modern understanding is regarding estrogen and breast cancer. You may be surprised that we are now flipping the script and realizing that estrogen not only has no effect on increasing breast cancer risk, but actually reduces the risk of dying from breast cancer if it's started early. Not only that, but estrogen also undeniably reduces the risk of colon cancer, osteoporosis, and particularly cardiovascular disease when it is started shortly after menopause.

We no longer recommend taking hormone replacement only for treatment of hot flashes and night sweats, or stopping it after any defined time period. The health benefits of starting it as soon as possible after menopause and taking it for life outweigh any risks for most women.

~ Dr. Susan

While the safety and benefits of menopausal hormone therapy (MHT) are becoming widely accepted, hot debate continues around dosing, delivery methods and how to monitor levels. Advisory boards including the American College of Ob/Gyn and the Menopause Society support the use of (MHT), but much confusion continues regarding ideal blood levels, whether to check blood levels at all, and optimal route of delivery. The dosing of both estradiol and testosterone varies 5-10 fold between methods such as patches, gels, sublingual methods or pellets. Both doctors and patients need to understand the dose that they are prescribing to make an educated decision. Today I will help to shed light on the differences between these options, and why my strong opinion is that blood levels are critical to ensure that levels are not too high or low for your optimal health.

Sometimes we have to be our own advocate and ask for the tests that we need since many doctors don't offer very high-level labs that can be critical to maximizing your healthspan and helping you to feel great. Today I'm going to go through a real patient's lab panel and show you what we look for in our office during a hormone consultation. I'll be discussing the difference between "reference ranges" and "optimal ranges" so that you can interpret your own lab values with a critical eye and make sure that you're not missing any opportunities for wellness. I'll include an actual copy of this patient's labs so that you can ask for exactly the same thing when you go to your doctor and you'll be empowered with everything you need to start on your wellness journey!

LINK - https://completemidlifewellnesscenter.com/private-practice/womens-fasting-panel/

If you do get these labs done, we can also discuss them with you virtually -or in person if you find your way to Houston!

So much has changed in our understanding of cholesterol and how it affects our risk for heart disease since I was in med school! Until recently we talked about "good cholesterol" and "bad cholesterol" with very little understanding of what those words actually meant. Today I'll attempt to unwind a little bit about what cholesterol does in our body, how to test for the particular lipoproteins that put us at highest risk for heart disease, the importance of ApoB, and most importantly what we can do to reduce our risk of heart disease based on this information. While this is often a largely forgotten subject for women, it's important to remember that the number one killer of both men and women is cardiovascular disease, and it is critical that we understand our own heart health, and how to optimize it!