Show Notes
In Today’s Episode
What if much of what women have been told about hormone therapy is missing important context? In this episode of the Table Talk Podcast, Melody Hartzler sits down with Mia Scott, FNP, co-founder of Rixa Health, to unpack the history behind hormone therapy fears, the Women’s Health Initiative, bioidentical hormones, individualized treatment, and why informed consent matters. Together, they explore how hormones can be approached through a personalized risk-versus-benefit conversation rather than a one-size-fits-all approach.
Key Take Aways
- Hormone therapy conversations need context. Mia explains how the Women’s Health Initiative contributed to widespread fear around hormones and why its findings shouldn’t automatically be applied to every woman, hormone formulation, age group, or route of administration.
- Bioidentical doesn’t mean “natural” or compounded. Bioidentical hormones refer to hormones with a molecular structure the body recognizes, and they can be available as prescription pharmaceutical products as well as compounded medications.
- Individualization is essential. Age, timing, symptoms, medical history, route of administration, lifestyle factors, and personal risk all need to be considered when determining whether hormone therapy is appropriate.
- Women deserve informed consent and options. The conversation highlights the importance of discussing both hormonal and non-hormonal approaches, particularly for women with a history of breast cancer or other complex medical histories.
- More isn’t necessarily better. Melody and Mia discuss the importance of avoiding excessive hormone dosing and instead focusing on appropriate therapeutic levels, symptoms, side effects, and the individual patient’s response.
Topics Discussed
00:00 – Welcome to Table Talk: Hormone Therapy
Melody introduces Mia Scott and her work in functional medicine, hormone optimization, metabolic health, and personalized care.
03:00 – Why Women Are Afraid of Hormone Therapy
Exploring the fears many women have inherited around hormones, including concerns about breast cancer, cardiovascular risk, and safety.
04:00 – Understanding the Women’s Health Initiative
A closer look at the 2002 Women’s Health Initiative, who was studied, the hormone formulations used, and how the findings shaped women’s perceptions of hormone therapy.
07:00 – The 10-Year Window and Starting Hormone Therapy
Discussing the timing of hormone therapy, bone and cardiovascular health, and why being outside the 10-year window does not automatically mean a woman is no longer a candidate.
08:30 – What Does “Bioidentical” Hormone Really Mean?
Mia explains the difference between bioidentical hormones, synthetic hormones, and compounded medications.
10:30 – Breast Cancer Risk and Hormone Therapy
Looking at the available research on micronized progesterone, estradiol, and the importance of understanding absolute versus relative risk.
12:30 – The FDA and the Black Box Warning
Discussing changes to hormone therapy labeling and how the removal of certain warning language has affected women’s willingness to consider treatment.
14:30 – Hormone Therapy After Breast Cancer
Exploring treatment options for women with a history of breast cancer, including testosterone, vaginal estrogen, and non-hormonal approaches.
18:00 – Personalized Medicine and Risk vs. Reward
Why hormone therapy decisions should consider each woman’s symptoms, medical history, risks, quality of life, and individual response.
19:30 – Why Menopause Education Is Missing From Medical Training
Mia shares her experience discovering how little menopause and hormone education she received during nurse practitioner training and why she pursued additional education.
22:00 – What Happens During a Hormone Therapy Consultation?
A look at Mia’s telemedicine approach, symptom tracking, medical history, laboratory testing, treatment planning, and ongoing follow-up.
23:30 – Hormone Testing and DUTCH Testing
Discussing serum hormone levels, urinary metabolites, DUTCH testing, and the challenges of balancing ideal testing with affordability and accessibility.
25:00 – Finding Therapeutic Estradiol Levels
Exploring estradiol targets, symptom relief, bone protection, and why hormone dosing needs to be gradually individualized.
27:00 – How Much Progesterone Is Enough?
A discussion about progesterone dosing, breakthrough bleeding, sleep, GABA receptors, and why higher doses aren’t necessarily better.
29:00 – Becoming Your Own Health Advocate
Why patients should ask questions, recognize when a treatment isn’t working, and feel empowered to seek another opinion when necessary.
31:00 – Transdermal Estrogen and the Patch Shortage
Discussing why Mia often starts with transdermal estrogen, differences between patches, and challenges caused by medication shortages and changing brands.
34:00 – Compounding and Reducing Unnecessary Ingredients
Exploring compounded medications, pharmaceutical ingredients, and Mia’s interest in reducing dyes, petroleum, and other unnecessary components.
35:00 – Testosterone for Women: Finding the Right Approach
A closer look at testosterone dosing, topical creams, injections, pellets, physiological levels, and the importance of avoiding excessive dosing.
38:00 – Hormones, Gut Health, and Histamine
Discussing hormone metabolism, inflammation, gut health, detoxification, and how these factors may influence a woman’s response to hormone therapy.
40:00 – Hormone Therapy Is an Art
Why there isn’t a single protocol that works for every woman and how providers can use different routes, doses, testing, and treatment strategies to individualize care.
40:30 – Where to Find Mia and the Rixa Women’s Summit
Mia shares where listeners can learn more about Rixa Health, her podcast, social media, and the upcoming Rixa Women’s Summit.
Resources Mentioned
- Studies & Resources Mentioned
- Podcasts & Media
- Find Rixa Health & Join us at the Summit!
Leading the way to better chronic disease management through functional and integrative medicine.