The Dr Louise Newson Podcast - 64 – Estrogen: separating fear from fact

Episode Date: May 7, 2026

Why are so many women still being told estrogen is dangerous?In this episode, Dr Louise Newson is joined by oncologist and author of Estrogen Matters, Dr Avrum Bluming, to explore how fear around hormones took hold and why it persisted for so long. They also revisit the evidence behind the Women’s Health Initiative and discuss what it actually shows about risks and benefits.Together, they unpack the role of estrogen in the body and why having the right information is key to making informed choices about treatment.We hope you love the podcast. If you enjoyed this episode, please make sure to follow us and leave a 5-star rating and share it with someone who needs to hear it.LET'S CONNECT  Subscribe here 👉 https://www.youtube.com/@menopause_doctor Website 👉 https://www.drlouisenewson.co.uk/Instagram 👉   / @drlouisenewsonpodcast  LinkedIn 👉     / https://www.linkedin.com/in/drlouisenewson/ TikTok 👉   / https://www.tiktok.com/@drlouisenewson Spotify 👉 https://open.spotify.com/show/7dCctfyI9bODGDaFnjfKhg LEARN MOREDownload my balance app 👉https://www.balance-menopause.com/balance-app/Get tickets for my new theatre tour, Breaking the Cycle 👉https://www.nlp-ltd.com/dr-louise-newson-breaking-the-cycle/ Pre order my new book 👉https://bio.to/ThePowerofHormones 

from Blooming, I feel very excited to have you back on my podcast. This is the third time. And we met many years ago before the podcast started and I was in London at the Royal Society. I was giving a lecture and you were there. And you just helped me open my eyes because sometimes in medicine, when you think differently, you have doubts and you think, really, it's so obvious. Maybe I'm missing something. And then you came and you had just written your book, Eastergen matters, and you had some slides that just had a few sentences on, very few about estrogen and heart disease and osteoporosis dementia. And I just thought, wow, he's just speaking a language, but you're just so, it's also obvious, but it's become so confusing. So you have from a very esteemed oncologist,

position, a thinker, very inspiration. And actually, you don't know it really, but you are a great mental to me because you're so solid in how you are. And when I wobble, I just think about you and it really helps me. But let's just think about estrogen. It's a hormone. Hormones are chemical messengers that have a role in our bodies. And somehow, for the last 30 years, especially or so, maybe 40 years, people have become very scared of our own hormone. And it just feels a bit weird almost. If I didn't know any medicine at all and didn't know any politics, didn't know any history, if I'd come from outer space, and I said, we all have this natural hormone in our body that has lots of biological effects. We know it can be beneficial

for symptoms and future house. Yet most women, when their levels are low, don't get it. They're not allowed it. They'll give another medication. It just feels a bit weird, doesn't it? As a man, I can tell you what problem. I can get hormones and we ought to look at other hormones. Thyroid hormone saves lives because people who are deficient in thyroid die prematurely and thyroid hormone, which they take for the entirety of their lives, allows them to live a normal lifespan. Similarly, cortisol. when used correctly, helps keep people alive. John F. Kennedy was cortisone deficient. He had Addison's disease, and although we didn't know it when he was president,

he was taking cortisone, and that also kept him alive. Somehow, estrogen hasn't been invited to the party, and it isn't a mystery. It is through the early 1990s, up to, depending on which paper you read, 40% of eligible women, meaning peri and menopausal women, were given hormones. And it worked. And then in 2002, there was a report that came out first as a press conference, followed one week later as an article in the Journal of the American Medical Association, that said hormones, which means, estrogen for perimenopausal women who don't have a uterus, and estrogen and progesterone for peri and menopausal women who do have a uterus are dangerous. They increase the risk of heart disease, stroke, breast cancer, and death. Well, that's frightening. And that was a

study that has cost $1,000 million. That's a billion, but when I say it is $1,000 million, it sounds even big to me. And it made headlines around the world, and it was headlined in the New York Times, and doctors were afraid to prescribe hormones, and women flushed their hormones down the toilet. And everything I said about that conclusion, everything has been walked back by the people who said it. But somehow the walk-back message hasn't gotten as wide an audience. No, and it's so interesting because even that study when you read it, there are some good points in it.

They have been completely ignored. So even the first glance really looked did show that osteoporosis was lower. And osteoporosis is a condition that affects one in two menopausal women. And personally, as a menopausal woman, I'm very scared of osteoporosis. So if I had been diagnosed as osteoporosis and had a hip fracture, my mortality would be greater than most cancers, actually. But people don't see it as a, you know, but that was a good news story. They showed that bowel cancer had a reduced risk. And actually when they followed up people who were only on estrogen, there was about a 22% reduction in breast cancer.

But I didn't see that on the front page of the headlines, you know. It hasn't made the same headlines. No, and I remember actually, so 11 years ago, I was asked to summarize our nice menopause guidance because as you know, I've been a medical writer for 25 years and a lot of my work was summarizing guidelines all across medicine and when you summarize guidelines, you don't just read the guidelines, you read the original references and the papers and you look at everything. So this was a big piece of work for me because I went back to WHO and of course I read it in 2002 and I wrote about it then that I wanted to look at it with a fresh pair of eyes.

So I went through it all and again and again and again. And I kept thinking, well, what's the big deal? Like, why is everyone so scared, actually? Because the numbers don't add up. And even if they are, it's really small. And even if you look at the worst, like, rate of breast cancer, it's still less than if I was smoking or drinking water or alcohol. You know, when you put it into a perspective.

But it's the benefits that people, people seem to forget. And also, even if we'll talk about disease prevention in a minute, but we've known ever since hormones were produced, you know, in the 40s, 50s, 60s that well-being can improve. Women can feel happier. And is that a bad thing, Avram, that we help our patients to just feel happier and better? I guess it depends in part how you feel about women. I, for one, am prejudice in favor of women. I think if women ran more things, than they do, this would be a better world. I attended a talk years ago that was given by Kim Campbell, who was a woman in her 40s and

she was the Prime Minister of Canada. And she said, let me tell you the difference about the way men govern and women govern. Men govern by fiat and power. Women govern by consensus. That was such a wonderful insight. That's amazing, isn't it? Yes. It really is.

And I know, you know, personally, when I was having hormonal changes 10 years or so ago, I wasn't really enjoying things. I mean, my memory was terrible, my concentration. But I just didn't enjoy life. It was really hard to just get up and be motivated and really small things, like really trivial things, like putting the washing on. I couldn't be bothered. And, you know, like now I just put it on and it's done.

And it's easy. And that sounds really small, but I think a lot of women listening will resonate with. You can't measure that in a study. You're not going to have a big study looking at do women put the washing on more or empty the dishwasher or, you know, say goodnight to their children with a loving kiss. Are they more likely to do that with hormones or not? But I know what the answer is. But that makes a big difference just day to day for most of us that have families or, you know, have partners. That's really important, actually.

And somehow that's forgotten. I remember reading that about 40% of women in the healthcare industry in Britain are retiring early, 40% around the time between 45 and 55 as they reach menopause. Well, that's terrible. What a loss to society to our general health. Yeah. And you can see why it happens. And, you know, I did some work with the police force a few years ago, and we did a big survey looking at symptoms. And it was the main symptoms were anxiety, fatigue, memory problems.

So it's not about giving us a fan at work or changing our uniform to a wicking uniform. It's not going to work, you know. So we need to think about this hormone estrogen. I mean, I've talked on other podcasts about progesterine and so testosterone, but I want to talk about estrogen because your book, which has been updated since we first met, estrogen matters. You know, most of my patients have bought it. We've got loads of copies in the clinic. And it's a real Bible because it's just common sense. But it's a hormone that affects every cell in our body. So therefore, it's every organ in our body. So I've already said there are some brain effects, as in people feel better and happier and smarter and they can think and sleep

and function. But it affects the bones, doesn't it? It helps keep the bones strong. What most people hear is the symptoms of menopause are really hot flushes, called hot flashes, but flush is a better word, hot flushes and difficulty sleeping. And it usually lasts a year or two and then it's gone. And that's so wrong. There are over 35 major symptoms, including heart palpitations, that respected cardiologists. I work with aren't aware of even today. And it's obviously all the genitone urinary symptoms and the loss of libido and painful sexual intercourse, even if you fake it and decide you will try it.

And the brain fog, which is devastating, and it affects 80% of women between the ages of 45 and 55, and it's significant. And it lasts a median of 7.2 years, not a couple of months. And for women of color, it lasts longer than that. And the single best treatment is estrogen, which works in close to 100% of women. And it's so interesting, the study that we spoke about, the Women's Health Initiative, that first came out as results in 2002. said in 2003 that estrogen has no effect on a woman's quality of life.

So not only did it cause, but it doesn't, heart disease and breast cancer and death, it doesn't even help symptoms. And that was a headline story also in the New York Times. And when you read that article, which obviously I've read very closely, This was a prospective double-blind randomized study. And the authors write in the article, we knew that menopausal women that were symptomatic would know within a week or two if they were getting a sugar pill and not the estrogen. And so we intentionally did not admit symptomatic women to the study.

And they concluded by the article by essentially saying, and these women who had no symptoms had no improvement in the symptoms they didn't have if they got estrogen rather in placebo. But the headline didn't say that. You see, it's so misleading, isn't it? And it's so confusing for women. And, you know, quite soon after I, you know, updated and went through the NICE guidance many years ago and started talking to doctors and also women, they were like, but that's not what

I've read. That's not what I've heard. And in medicine, if I'm not sure about something, I'll go back to the original. And I'll also go back to basic physiology, because, you know, you, as I have, have prescribed all sorts of drugs. And you can't just write the name of a drug on a prescription. You have to know how it works in the body, because then it helps you know, is it going to be beneficial? Is it going to have risks? You know, you're constantly weighing up. Is it going to interact with other medication? What do I inform my patients? And so much of this is very simplistic medicine. You know, you talked about underactive thyroid. It's very similar.

But then there is still some people saying, but menopause isn't a hormone deficiency. And it's like, well, what is it then? Because our hormone is low. It stays low forever. And we have to be facing the consequences of these low hormones. And as women, we should be able to choose whether we want to take hormones or not. and I wouldn't be carrying on my work if everybody who wanted hormones

could easily get them because I'd be thinking well that's great but the stories I hear and I'm sure you hear them in the US as well everyone is women are being given antidepressants they're being in sleeping tablets

they're giving treatment for their palpitations for their migraines for their restless legs you know the list goes on they're being treated for their symptoms but if they ask for estrogen or hormones it's almost like well no that's that's you know

So not really what we do. Since we published the first edition of our book in 2018, I've gotten letters not just from around the United States, but from all over the world. The book has now been translated into Spanish and German and Chinese and there's a Polish edition that's coming out soon. And I get letters from Bangladesh and Senegal all over the world. And it's the same thing. Women are facing that same problem. And it's worth pointing out that you and I can banter back and forth and say, we've known each other now for over seven years. And we've been in agreement since the first minute we met. And that has just gotten stronger. And so people listening saying, well,

fine, these two people agree. But I hear people who are respected disagreeing. And the answer is, there really isn't that kind of disagreement. And it's important to know that. Although the Women's Health Initiative came out first and said it increases the risk of heart attacks and death from heart attacks, their population had a median age of 63. Less than 70% of the women were over 60, between 60 and. Very few were in the target population that we're talking about. More than half were markedly overweight.

Close to half were smokers or previous smokers. This is a population that had a much higher risk of heart disease than the one we're talking about now. And what the Women's Health Initiative now says and has published, but the New York Times hasn't reported, nor the London Times, is that when taken within 10 years of the last menstrual period, it actually decreases the risk of heart disease. And that's what so many studies over the years long before 2002 have confirmed. You mentioned osteoporosis, yes,

a hip fracture from osteoporosis, which can affect a significant number of postmanipausal women, is associated with death within, one year of the hip fracture that mirrors the incidence of death from breast cancer. And the best treatment is estrogen, much better than calcium, which alone doesn't work in a postmenopausal women and the other drugs that are used for osteoporosis, that when they work in prevention, work for five years, but after that are associated with an increased risk of hip fracture, estrogen you can keep on using and it works as long as you use it. And although they originally published in 2003, it has no effect on quality of life.

They've now walked that back and said estrogen is the single best treatment for menopausal symptoms. And they initially said that our findings apply to women of all ages. And they've walked that back and now said, no, the bad findings really were for women who were long past menopause. And now they said, we're so sorry that Perry and menopausal women weren't started on estrogen. That wasn't what our intention was. Well, that's what you wrote, but you've walked it back. Let's publicize that you've walked it back.

And when challenged, the disagreement isn't there. When people say, I don't know who to believe these two people now who I'm listening to or other people. Well, we all agree. It's just we're saying it out loud. Yeah, and that's so important. But actually, you know, a few weeks ago now, the FDA did their lovely announcement about removing black box warning. And, you know, it's really lovely when you hear other people saying the same things. well because it's very reassuring. You know, a lot of my patients, a lot of people I speak to

are confused because they've had mixed messages for so many years about hormones. But I often think in different ways. And one of the things I think about is the risks of not having estrogen. So we can talk and we'll be still talking for decades to come about the potential risk. But just to be clear, they are small risks if they are there, depending on the dose, the formulation, the person that's been having the medication, but the risks are very small. But the risks of not having hormones you've already alluded to. If we don't have hormones, we've got an increased risk of all inflammatory conditions. So heart disease, osteoporosis, diabetes, dementia, even depression, schizophrenia, chronic kidney disease.

You know, the list is quite long, actually, and women are living so much longer. So women need to be involved in their decision, about are they prepared to take a risk? It's the same as, you know, am I prepared to take a risk if I don't exercise or if I eat processed foods? I need to be educated as a person about that. But I think we need to, as women and patients, take responsibility and think about the risks of not having hormones.

And let's talk about risk again for just a minute. As you pointed out, the black box warning, which was put on all estrogen-containing drugs, warned, increases the risk of heart disease and breast cancer. Estrogen alone in this very big prestigious study decreased the risk of breast cancer, decreased the risk of breast cancer by 23%, and even more importantly, decreased the risk of death from breast cancer by 40%. And nobody argues with that. That's what the Women's Health Initiative published.

So the only thing that they're left with of everything they were waving red flags about is they say, but when you add progesterone to estrogen for women with a uterus because estrogen alone does increase the risk of uterine cancer, well, the risk is small. Actually, that risk is non-existent. That's a non-risk. And it doesn't increase the risk of death from breast cancer. and I've written numerous articles saying that that one extra woman per thousand is based on a misrepresentation of their own data. When you analyze the data and balance it per their own protocol, even that risk disappears. But what women say when they hear me say that is, well, I don't want to be that one in a thousand. Well, it's not a real number.

It's an artificially generated incorrect number, and women are still staying away from hormones because of it. And it's such a shame because, you know, breast cancer is common. It's far more common now than it was when the WHOHI was first launched. Yet HRT and estrogen prescribing is so much lower. So there are lots of reasons, you know, as well as I do, why people have cancer. But you've already said also that women who only have estrogen have a lower instance of breast cancer. But women will get breast cancer, whether they take hormones or not,

whether they do exercise or not, whether they drive their car or not. You know, we have a risk. And the problem is, is that because of some women who take HLT develop breast cancer, it's very easy and quick sometimes for other doctors to say, oh, well, of course it's your hormones, especially because you've got an estrogen receptor positive breast cancer. And that causes still now a lot of confusion, which is such a shame. Well, confusion usually is associated with ignorance. And as I told you before we started talking, I say I don't know many times every day. You said, well, of course we know there are many reasons for cancer development. I'm a medical oncologist. I've been a medical oncologist for close to 60 years. And I don't know what cancer is. I know how to treat it

based largely on trial and error studies so that now a newly diagnosed breast cancer carries a cure rate of close to 95%. I don't take breast cancer lightly. It is still a disease I don't wish on anybody and I've spent a large portion of my career treating it, but it's very small in terms of a risk for a shortened lifespan. And if the numbers don't even show that it increases the risk, then putting the black box warning and preventing women from taking it is a huge disservice. And that's what Dr. Marty Macquarie, who is the FDA commissioner, said when he said, and we therefore, after looking at all the data, are removing the black box warning on all estrogen containing products, not just vaginal estrogen, which nobody has really challenged,

but on all estrogen-containing products, Bravo. The next battle is what about breast cancer survivors, even as... receptor positive breast cancer survivors. And the short answer to that is, of course, we need more data, but there are 26 studies in the medical literature looking at what happens when breast cancer survivors are given hormones, including estrogen receptor positive breast cancer survivors. And of those 26 studies, 25, say there's no increased risk of recurrence. In fact, four of the five prospective randomized studies say there was a decreased risk of recurrence. And the one study that said there's an increased risk of recurrence, which not surprisingly,

is the one most quoted in the medical literature called the Habits study for hormones after breast cancer, is it safe? A study done in Sweden said there was no increased risk of distant recurrence, meaning metastatic tumor, there was no increased risk of death, but what we saw is an increased risk of local recurrence in the affected breast or in the contralateral breast. Well, this particular study did not mandate imaging of the breasts before these breast cancer survivors were admitted to the study. So you don't know if the hormones increased the risk of breast cancer, and of the several hundred women followed. The actual difference between the women who were randomized to nothing and the women who got

hormones were 22, an absolute number of 22 women. And it's on the basis of those 22 women where imaging wasn't required as a prerequisite, that millions of breast cancer survivors are being. denied hormones. And so that's another issue that we now have to face and deal with. Absolutely. And the stories, we published some data looking at the stories people are given, actually, from healthcare professionals about menopause when they've had breast cancer, or rather than not given information, but also some of the stories where women are just refused any hormones. And, you know, I see a lot of women in my clinic who have had breast cancer

10, 20 years ago. They're more worried about their personal risk of osteoporosis than they are of a recurrence. And so it's so, and we've spoken about the studies in depth before, but it's, it's very much about individualized choice. And I think that's where we all agree, actually, or we should all agree, but I think we do as clinicians that our patients should be allowed to choose and we need to be able to have grown up conversations because we're not going to have all the studies. We'll never have all the studies. And even if we do, you know, those women in the WHOHI are not me. They're different. They'll eat differently. They'll exercise differently. They'll have different genetics. So I, you know, even then, that risk is not my risk. So we have to be taking responsibility and sharing uncertainty.

So we've got a long way to go. One of the most enlightening talks I have heard within the past several years was by Dr. Eric Weiner. Warner is a former past president of the American Society of Clinical Oncology. He ran the breast cancer program at the Dana-Farber Harvard's Cancer Center for years. And several years ago, he moved to Yale. He's now the director of oncology. And the title of his talk was Physician Patient Partnership, the cornerstone of medical treatment and.

and research. Physician, patient, partnership. When a doctor says, we're not going to talk about it, and if you insist on even discussing estrogen, you'll have to find a different oncologist. That's the wrong doctor. That's an inadequately informed doctor, but that's the wrong doctor. And you have to know that Dr. Weiner was born with hemophilia, that he got factor eight to treat. his hemophilia and that gave him AIDS as a young boy and in spite of that he's gone on to be this incredibly impressive inspirational leader and he's been on the patient side of the desk he knows very well what it's like to be dealing with physicians who are less supportive than they should be and less informed than they must be it's so important

So I'm very grateful for you coming today, and hopefully you'll be on a fourth time in the future. But before I end up, I just always ask for three take-home tips. So three ways that women can be better advocates for themselves. And, you know, I think this is really important because a lot of my work is reaching women and letting them choose. So what are your three tips for being better advocates for your health? Well, the first is humility. both on your part and on the part of the physician. Because you're not going to go into a store and buy this off the shelf.

You've got to work with the physician. So humility is appropriate, but humility is not shyness. You must be educated, which is why we wrote Estrogen Matters. Carol Tavaris and I wrote the book so that women can have up to day. information, as can the men who care for them, as can physicians. We wrote the book, the way we write papers, clinical papers. Everything we say in the book is extensively referenced so that you can say to the physician, well, what about this? This isn't just some crazy doctor in Southern California. This is referenced work that comes from academic institutions around the world. And I need you to look

at this and work with me. That's one part of it. The second part of it is certainly in the United States, we live in a litiginous society and nobody wants to be sued. And if a doctor is going to give a breast cancer survivor of estrogen, regardless of whether it was an estrogen receptor positive or estrogen receptor negative tumor, some women are going to recur because stuff. happens. And to avoid suit, the physician can be offered by the patient an informed consent form, which we have put up online on our Instagram site in which I can send you if you want, so that the patient can say, look, doctor, I understand the fear of being sued. And I am willing to sign an informed consent form saying, you spoke to me about this. And we will

share responsibility and I will assume that risk, which based on everything I know, is minimal, if present at all. So that's number two. And the third is we said that women ruled by consensus. Well, fortunately, there is a consensus that you have helped generate now of women around the world that says when we work together, we are stronger. And so those are my three suggestions for how to deal with this in the future. That's lovely. But we do allow a few men when we work closely and stronger together, Reverend.

So you are very much included in what we're doing. I'm an honorary member of the menopassin, which is very powerful. It's lovely to have others that we support because that's what's needed to make a difference. So thank you so much. It's been brilliant. It's always a pleasure.