A Conversation With Dr. Tara Scott On Hormone Imbalance in Midlife
Understanding hormonal imbalances in one’s 50s is crucial due to the significant impact these changes can have on overall health and well-being. As women approach their 50s, they undergo menopause, a natural phase marked by a decline in estrogen and progesterone production. Hormonal imbalances during this stage can contribute to an increased risk of health issues such as osteoporosis, heart disease, and certain cancers.
Recognizing these changes and seeking appropriate medical guidance empowers individuals to make informed decisions regarding lifestyle adjustments, dietary habits, and potentially hormone replacement therapies, ensuring better overall health and quality of life in their 50s and beyond. I sat down with board-certified OB-GYN Dr. Tara Scott to discuss the challenges of living with hormonal imbalances in your fifties and beyond.
Alexis – Thank you so much for joining me today, Dr.Scott. I really appreciate your time and willingness to share your expertise with this community. So, tell everyone a little bit about yourself.
Dr. Scott – Sure, I’m Tara Scott. I am a traditionally trained OB-GYN. In my own personal health journey, I had a lot of problems with infertility, which led to my interest in hormones, fueling my desire to gain a better understanding of hormones and bioidentical hormones. I became certified as a menopause practitioner by the North American Menopause Society.
Almost 14 years ago, my brother suddenly died at the age of thirty-eight, he was a diabetic and had a heart attack; he had every risk factor. I felt it was totally preventable, so I decided to shift my focus a bit, still hormones, but prevention and wellness.
So, I completed a fellowship in functional medicine and became board certified, my third board certification in integrative medicine. Which led to my retiring from OB-GYN in, I think, 2016. I haven’t delivered a baby in years. I did both for a while, upstairs, and downstairs. I really loved OB-GYN. I loved my patients. One thing I loved about OB is, that I had people who I delivered come back and then their daughters became my patients, you know, like three generations. I really loved it.
It was a little bit crazy of a lifestyle when I was delivering babies, I opened my practice Revitalize in 2013, and in 2016, I kind of concentrated just on integrative and functional medicine. I currently run Revitalize, and I’m the medical director for integrative medicine at our local hospital, Summa Health. They have five or six hospitals and some freestanding surgery centers.
Aleis – That’s amazing, Dr. Tara. Sorry to hear about your brother, losing a sibling can be life-altering, my condolences. When I shared with my audience that you would be on to talk about all things hormonal imbalance, one of the first questions received by our readers was, what are some signs of hormone imbalance as it relates to midlife?
Dr. Scott – One of the first signs involves a noticeable change in your monthly cycle. Some people are lucky enough that they have a regular period every month and then it stops and it’s menopause. But most people aren’t like that. So, as soon as your period changes within one week, whether it’s 28 days and now it’s 22 days, or whether it’s 28 days and 35 days, technically that is a definition of perimenopause. And that is the time when your hormone levels can start fluctuating, it’s like a roller coaster.
You could have high estrogen one month, and low estrogen another month. That’s the biggest first sign. And, then there are those who don’t really have any of those problems, it might be hot flashes or night sweats. One sign that is most common, is poor sleep, anxiety, and weight gain. If I were to poll women in their 40s I would find that many are experiencing new onset of anxiety.
They didn’t have it as a kid, or early adulthood, but is not faced with what can be crippling anxiety. Life is stressful, but they go to their family doctor and the first thing they’re offered is an antidepressant or other medication for the anxiety, which is nothing against those, they can be helpful, but it doesn’t treat the reason, so you’re still left with the reason, not knowing what you’re experiencing is, in fact, a hormonal imbalance.
Alexis – Wow, you know what, now that I think about it, you just describe what I’m going through.
Dr. Scott – And as I said, sometimes those medications really, really work, I have nothing against prescribing those medications, what I would say is, can you find out why? and if you find out that is in fact, the reason for what you are experiencing, ok great.
Alexis – Thank you for mentioning the importance of differentiating regular stress, versus those associated with hormonal changes.
Dr. Scott – Yes, stress derails all of your hormones, your thyroid, your cortisol, which is your stress hormones, your female hormones, and your male hormones, it derails everything. It turns everything into a different situation. Three out of four doctor’s visits are because of stress-related illness.
So, if we were more holistic and treated people with stress, we would probably not have a lot of the medical issues we have. But we’re really taught as traditional doctors to look at the symptom, make sure it’s not cancer, heart attack, anything life-threatening, and in the absence of that, treat the symptom, not to really look for the cause, just rule out anything really bad and then treat it.
Alexis – Who would one go to have their hormones checked?
Dr. Scott – I get that question all the time. I am an OB-GYN, but I can tell you, we do not receive as much training as we should. Tomorrow, I’m scheduled to lecture the new residents at my hospital. I try my best to include education on the importance of hormonal changes, so they get some hormone education, but generally, most places do not focus on such education.
There are definitely outliers, right? Like myself, I, as a practicing OB-GYN, would never say, don’t go to your OB. That would be the first place to start, and if you’re met with the attitude of, oh, we don’t check hormones type of answer, then you need to look elsewhere. For example, the Dutch test is one type of testing done in our practice, it’s a dried urine. This is a test not normally done by your regular OB-GYN.
Alexis – I know you mentioned the Dutch tests, right? What other tests should we ask for, or expect of a practitioner?
Dr. Scott – We do about four different types of testing in our practice. I would be cautious of providers who only perform one type of test, because there is no perfect test, right? So the way I explain testing is to think of it this way, if you’re a census taker and you come to my house and you want to see how many people live at my house, if you come into the living room and you see my husband and I sitting there and you say two people live here and you leave, that wouldn’t be accurate, right? Because I’ve got one kid away at college. I’ve got my son in the basement playing video games, and my daughter is in her room FaceTiming her friends, right? It is the same with our bodies, there are different compartments of the body.
Blood is just one compartment of the body. Now, blood is the best place to look at your white blood cell counts, your cholesterol, and even things like your thyroid hormones, because those are really big hormones. And, any hormone that your brain produces, TSH, FSH, prolactin, all of those are best in blood.
But when you’re talking about your ovarian hormones, like estradiol or estrogen or progesterone, it could be the right place to start if you’re still having periods. But say you came to me and you had your ovaries removed. Well, you’re not going to have anything in your blood, because your hormones are coming from your adrenal glands and they’re changing your tissue.
And the way I explain that is, say my 19-year-old leaves on a Friday night in sweats and says, I’m going to go study, Mom. And I think, oh my gosh, she’s such a good kid, and she goes to her friend’s house, changes into a tank top and a mini skirt, gets a fake ID out, and goes clubbing, right? But I don’t see her change because it’s outside of my house.
So hormones change into other things in your muscles and your fat. So, sometimes we want to see the water, and the tissue levels. The theory is that when you spit into a tube, the blood goes to the saliva and the saliva releases those proteins that carry the hormones in your blood, and that is another way to measure.
So for a long time, we were using saliva testing to measure changes in your body. Are you changing into more estrogen? Now, the dried urine came about in 2015, so not that long ago, the urine test looks at metabolites. So when you pee, everything has already gone to your body and it gets out of your body, right? So it’s not really what’s circulating in your blood.
Another way to look at it is, if I asked you to do my taxes, I just gave you the balance of my savings account, that wouldn’t help you, right? You need to see how much I pay in rent, how much was payroll, how much I make; you need to see all receipts. That’s what the dried urine test does, it shows what your body does, and the several stages of breakdown.
Alexis – What factors determine which test to run on someone? Is it based on life practices, and overall health?
Dr. Scott – It’s based on first, age, obviously. In someone who’s sixty, and has no ovaries, I might not do blood testing, because they’re not producing any in their body from their ovaries anymore. While someone who’s thirty-five or forty and still have periods, we could start with blood testing.
And, if someone is on hormones versus not on hormones, people who have breast cancer, fibroids, endometriosis, anything that makes me think they have something wrong with the way they process estrogen, or they have a lot of estrogen, I prefer the dried urine test for them.
Alexis – Okay, perfect, wow! This is great information. Now, when should one consider hormone replacement therapy, and what are the options?
Dr. Scott – That’s another great question. So the average age of menopause is fifty two. I believe there was a study done almost 20 years ago that was done on synthetic estrogen and synthetic progestin. The study was done with a collection of urine from pregnant horses, where estrogen was taken out of the urine, this estrogen is one our human bodies can’t break down very efficiently, which was beneficial for the study.
They found that after five years, women 65 and older, had an increased risk of blood clots and breast cancer. This made national news, I saw it on Good Morning America, everyone panicked. And to this day, 20 years later, people still think about that study.
Another was done to to determine the differences in taking estrogen as a pill versus through the skin, like a patch or a cream.After a total of 17 different studies, it was concluded that when you take a pill, you swallow it, it goes through your liver. Which is where our blood clotting proteins live, so it explained why there was an increased risk of blood clots.
But when you wear a patch or use an estrogen cream, the risks of blodd clots was nonexsistent. So, that is the reason we don’t use oral estrogen, or any estrogen tablets. So then the next question is, what about breast cancer? So there was another study that was done in Europe, with five times more women between the ages of 40 to 64, the women who took a natural progesterone and a bioidentical and natural estrogen patch had no increased risk of breast cancer for eight years, the study compared to women who took no hormones. So, the North American Menopause Society says, taking all of the studies into consideration, when it comes to women between the ages of 50 and 60, the benefits outweigh the risks, unless you personally have a reason not to take it.
Alexis – Wow, this is amazing information. And so what people don’t realize is that the death rate after a hip fracture is much higher than 10 years after breast cancer. But people fear cancer more.
Dr. Scott – Absolutely. The biggest cause of death is heart disease. And estrogen is good for your heart.
Alexis – Wow, wow. I love this. Now, are there instances where hormone therapy is not beneficial or is not suggested for a patient?
Dr. Scott – So we always measure levels before we test anybody. So if you are still making a lot of estrogen, you don’t need to take it. It’s kind of like financial aid. You fill out the FAFSA form and if you make enough money, you’re not going to get financial aid, right? If you need financial aid, you’re going to get it. So that’s like hormones, it really depends on what your body is doing. Now, if someone themselves has breast cancer, we don’t generally give them estrogen.
I saw a patient today who had cancer 17 years ago and wants to begin hormone therapy, the further away you are from your last bought with cancer, and depending on the kind of cancer there are a multitude of options. And generally, if you’ve had a history of blood clots, like a blood clot in your lungs, we are really careful about that prescribing hormone therapy. We certainly would not give you the oral estrogen. You may be able to take the estrogen patch, but it really depends. The other type of cancer that is fed by estrogen is melanoma. So if you have one of those cancers, we would be pretty careful with what is prescribed to you.
Alexis – OK. Now, let’s talk about food, what role does diet play? We know, of course, it does, but what foods should one stay away from? Which should we incorporate?
Dr. Scott – It’s huge, actually. Estrogen and insulin are connected in your thyroid, so as you approach midlife, you become more carb-sensitive. I’ve had patience who would say, it used to be that I could eat a lot for a week and still lose the weight, and now I can’t, even though, I exercise and eat very little. So, eating fewer calories and exercising more will not help you lose weight if your hormones are not balanced.
I see it all the time, and people get frustrated because they go to their doctor complaining of weight gain, or difficulty to lose weight, and their doctor would say, you just need to eat less and exercise more. And, these poor women are like, I am, you know, because I ask them, I ask all my patients, what do you eat? Like typically, some of them are not eating that much.
They consume the appropriate number of calories and exercise, yet can’t seem to lose weight. That’s because their insulin levels are dysregulated, thyroid gets sluggish when you have a problem with estrogen. So in general, lower carb or a modified paleo or even a keto for a short time is a better option as far as the macros. Women don’t eat enough protein. It seems like they need about one milligram per kilogram of their body weight. You know, eight to one.
I think people do better without big bursts of carbs, like 40, or 50 grams of carbs at lunch or whatever. So less carbs. And then you also want to pair it with a fat. I see a lot of women also don’t eat a lot of fat, you know because you think of fat, you think of steak, bacon, and butter or whatever, when you should be thinking salmon, avocado, some nuts, oil, those things.
And there are also foods that help your body detox from estrogen, broccoli, kale and cabbage, those are the cruciferous vegetables, asparagus. Those are better. Also, blueberries. Berries are really good as well.
Now, sugar is not your friend. Now, let me be honest, I have a little bit of a sugar problem. I have just recently discovered this keto cookie dough, which is really good. And it has almond flour in it. It is sweet. I think it’s got monk fruit in it, but it doesn’t spike my blood sugar. So that’s good. Eating too much sugar can slow down the way your body processes estrogen, as well.
And since estrogen control inflammation, and estrogen drops in midlife, you can also experiace issues with inflammation. So a lot of times women will also have more success with cutting out inflammatory foods, such as sugar, gluten, possibly dairy, too.
Alexis – This is such useful information. Now, if one should consider hormone therapy, is that something you can do long term?
Dr. Scott – That’s another great question. So we know that between the ages of 50 and 60 or within 10 years of your period stopping, it seems to be more beneficial than risky. Now, there was a belief, after a study done in 2002, tthat said five years, but that no longer applies.
The recommendation from the American College of Obstetric and Gynecology says if someone gets to the age of 60 or 65 and you try to take them off hormone therapy and they have a lot of symptoms, you could keep treating them. You know, and we always say the lowest dose, the safest dose. We are seeing more and more studies come out, though, with cognition and brain health benefiting from taking estrogen.
So what I generally do is if my patient is on it at the age of 60, we have a discussion. Do you want to try to go off? Do you want to try something else? I would say maybe 40 to 50 percent say, yeah, I want to get off, I don’t want to take it forever. And we beging to wean them off and see how they feel. Some of those people go off and have no problems.
Some need to stay on. Now, you kind of alluded to that sandwich generation, right? You’re taking care of your kids, you’re taking care of your parents and you’re still working. So there’s so much more stress then. But somehow at 60, maybe women don’t have as much stress, they seem to just do better without it at a later age than they do if they’re trying to go without it. In their 50s now, there are some women who really can, you know, do without estrogen, but it’s a personal choice.
Alexis – Now, are there differences between lack of progesterone versus any other? Because I have this question for myself.
Dr. Scott – Yeah, that’s a great question, too, because you know what? The body is able to make estrogen very easily, even without your ovaries, because it comes from testosterone and it comes from DHEA, which is in your adrenal gland. But most of your progesterone in a woman is made from ovulation. So if you no longer ovulate, you’re not going to make as much progesterone.
And as you age and your eggs get older, you’re not going to make as much progesterone. You can make a small amount from your adrenal gland. And, believe it or not, all of those hormones come from cholesterol. But, you can make a small amount, but it’s usually imbalanced.
And plus, we have so much in our environment that acts like estrogen. Plastics, you know, pesticides get in the way of how your body metabolizes estrogen. We have all this, you know, BPA. We have all this stuff in our food, you know, in our meat, how they were giving things to beef up the cattle or to, you know, make the chicken breast bigger.
So, I mean, the food practices I’m not an expert on. I think it’s gotten a little bit better. But there are definitely environmental sources of estrogen, which is why a lot of people end up estrogen-dominant.
Alexis – Ah, OK, OK, I see. Now, someone asked which test is the most important test when it comes to those with dangerous health conditions. Like if you have other, I guess, chronic illnesses?
Dr. Scott – It really depends on the chronic condition, but if you’re talking about dangerous health conditions, like we’re worried about the estrogen amount, then it would be the Dutch test, because we get a lot of information about your cortisol. We get information about how you break down estrogen, and how you break down androgens.
So that would probably be my favorite for the amount of information you get. It really depends on what it is. If your dangerous health condition is your cardiovascular system, then blood is going to be good because we can check your cholesterol and we check an advanced lipid profile. We can check inflammatory markers. So it really depends on the condition.
Alexis – OK, now someone want to get back to the hormone replacement therapy. Are there any natural ones?
Dr.Scott – So it’s funny, when you say natural, people think, does that mean that it just occurs in nature? Well, not really, because we used to give hormone therapy in the 1960s, they took it from pig ovaries, so that’s natural. It occurs naturally. But that’s not how we give it now. We make it in a lab to mimic our own hormones. So think about a diabetics. Many may not remember this, but in the 90s, we had beef and pork insulin, but now we’ve figured out how to mimic human insulin.
And now diabetics get human insulin that’s chemically the same as our insulin. It’s the same with estradiol and progesterone. We figured out how to take a Mexican yam, kind of change it a little bit, and make progesterone or a form of estradiol. Now, there are still synthetic drugs in the market like Premarin, Prempr, those are made from collecting horse urine or making progestin in a lab.
Alexis – OK. Wow. Now, what advice would you give to women in the beginning stages of menopause?
Dr. Scott – I would say the biggest thing is you should really know your levels, right? It’s not that everybody needs to take hormones, but you should know. Just like, you know, we filled out the FAFSA form and didn’t get any financial aid for our kids. But you have to fill out the form and check your hormones. Because it’s best to be preventative.
What if you’re feeling fine? And the reason you’re feeling fine is because your body is making a lot of estrogen and you’re not making enough progesterone. So you’re not having hot flashes. You’re not having any of the traditional low estrogen symptoms. But that estrogen is feeding growth in your breast. That’s not good either. And leading to an increased risk of breast cancer. So I think the biggest advice, if I had to say one, is really know your hormones.
Now, I understand there are limitations because not everybody knows how to check them. And I know people generally, it seems like a lot of patients are searching and they’re not getting a lot of help from their traditionally trained doctors. So, the second thing I would say is food is medicine. I mean, you can affect your health by affecting your diet, by doing some of the things that we said.
Alexis – Now, can you tell us what you do exactly in your practice as it relates to this?
Dr. Scott – Sure. So we see people from when they start their periods until, you know, I don’t know, I think I have an 80 year old in my practice. Maybe there’s no I mean, probably not older than that. And so the majority of what we see are women. But some of my partners do see men and do male health and check male hormones. We see a lot of functional medicine for your gut and for other causes and mold and things like that. But the majority of the people coming in, are people like you and me that have some hormone complaints.
And so after they see us, we take a detailed history, so it really just depends on what their specific symptom is, how old they are, if they have ovaries, if they’re still cycling, what we decide to do first. Are we going to do a blood test first? Are we going to do a saliva test or a urine test first? So then we generally do some kind of testing and then talk about. Here’s what it looks like, here’s your hormone balance, here are your levels. Here are the risk benefits and alternatives.
We do quite a bit of thyroid monitoring as well. We then try to get them on a program. Now, if you came in and said, absolutely, I don’t want to take hormones at all, then I would say, OK, here’s what your levels are, here are the risks and benefits, and since you don’t want to, here’s what we can do.
Alexis – Now, you mentioned gut health, is there a correlation between that and hormone imbalance?
Dr. Scott – Absolutely. So, I mean, everything is connected. So, as I mentioned, what you eat can trigger your hormones. But when your body makes estrogen, your detoxification from estrogen is in the liver. But then after it goes to the liver, it gets dumped into the intestine. So if you’re not pooping every day or you have some issue, that bacteria can use an enzyme to send that estrogen right back into your system. So it can cause, not necessarily a backup per se, but it can also contribute to high levels of estrogen.
And if you have a lot of stress, I know when I’m stressed, the first place I feel it is my gut, so it can affect your digestion and it can, you know, for an easy way to explain it, just irritate the lining of your gut and cause other issues. A lot of times you get new onset food intolerances where things that you used to be able to eat, you can’t eat, or maybr even hives and a rash.
Alexis – Oh, wow. OK, I had no idea. hat about supplements, which do you recommend?
Dr. Scott – I try not to load patients up with a million supplements. Obviously, the first thing we do is diet, but there definitely are some key supplements that are good. One of the most important ones is vitamin D. You know, where I live, nobody gets enough sun. Now, I live in Northeastern Ohio, which is, you know, very cloudy. So vitamin D is a good supplement. Magnesium is one of my favorite supplements. Almost everyone can benefit from taking magnesium.
Alexis – Thank you so much for you time and thourough interview, Dr. Scott. We must do this again, I feel we still have so much more to cover, I hope you don’t mind come back another time.
Dr. Scott – Thank you, Alexis. It was a pleasure to chat with you, and yes we should do this again, I am definitely open to another chat. Have a great day.