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

Iron is a vital micronutrient that is sub-optimal in more than 50% of women. This is frequently missed because it masks as many other things, and most doctors don't check the labs that are necessary to evaluate this completely. Today I'll be talking about where we find iron in our diet, how to diagnose low iron and how to address it by evaluating our input, absorption, and ruling out any sources of blood loss. I'll also tell you about my own story with low iron, how I corrected it, and how both my patients and I feel so much better when our iron is optimized!

We all know that alcohol is a toxin with numerous effects on our health - from weight gain, to sleep and mood disruption as well as causing multiple cancers, diabetes, heart disease, gut dysbiosis, liver damage and dementia - even at "socially acceptable levels." Many of us drink in moderation and don't consider it to be a "problem"- but today I'm discussing an interesting way of reframing your relationship with alcohol and being very clear about where it might be causing problems in your life.

I came across an amazing community called "One Year No Beer" (link and tag on social) and joined their 28 day alcohol free challenge. This challenge is supported with emails, videos and connecting with others on the same journey, and invites you to experience how you feel without alcohol for a prolonged period. Like me- a break from drinking makes most people realize that we are being held back by alcohol, and without it many things improve! My personal goal is to be someone who drinks "as much as I like as often as I like"- which will amount to very little, and not very often.

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.