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Womens Health Bulletin Board

Women's Health & Hormone Review

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345 Bayshore Blvd, 1702
Tampa, FL 33606
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Volume III, Winter 2003

Women's Health Initiative Study is Not About H.R.T.

Last summer, millions of middle aged and older women woke up to some shocking news: The daily regime of the synthetic drug, Prempro, they had come to depend on to treat their symptoms of menopause seemed to have turned against them. Doctors conducting the major study on Prempro had suddenly halted the research due to a higher incidence of breast cancer and heart problems among the Prempro users. The study that started all of the chaos across America was the Women's Health Initiative.

In the following months, millions of women threw away their hormone pills due to an unrelenting barrage of media coverage that warned about hormone replacement therapy in general. But lost amid the headlines and the hysteria was something crucial, the facts. That fact is that this study only answered a very narrow question about one treatment used for menopause symptoms. Although the WHI researchers chose their words carefully when communicating the findings of the study, they were not careful enough. Women and many doctors were left believing that all menopause hormone therapies- not just Prempro- were dangerous and no longer an option for dealing with menopause. This was a study about a synthetic drug NOT hormone replacement therapy or H.R.T. "It was never the intent of the WHI Study to scare women away from hormones for relief of menopause symptoms," said WHI physician researchers.

"There may have been an element of going overboard, " says Harvard professor JoAnn E. Manson, chief of preventive medicine Brigham and Women's Hospital in Boston and lead author on the WHI's heart report. "I think it's going too far for the study to be interpreted as saying hormone therapy has absolutely no role in clinical practice any longer."

So what conclusion can we draw from the WHI study? "One thing we can't say is that it means hormones aren't good for you. That's unfortunately the connotation that's been attached to it.," says Alan M. Altman, an assistant professor of obstetrics at Harvard Medical School. What we can say is the study showed that taking this synthetic drug is a very risky proposition. Women taking Prempro in the study had increased rates of breast cancer, stroke, pulmonary embolism and heart disease. Because of this, the study was halted in July 2002 and obviously for good reason.

Nothing from this study should preclude women who need the hormones to take the hormones unless you're at a very high risk," says the WHI's Dr. Stefanick. "Whatever was said 15 months ago, that's when it was a shock for everybody. We've had a year to calm down and get back to the fact that there still is a place for hormones for treating women."

SOURCE/REFERENCE: Reported by the Wall Street Journal on the 21st October, 2003

Natural Hormones versus Prempro and Premarin

"The medical reports are not about your own hormones. They are about patented, chemicalized hormonal substitutes," says Uzzi Reiss, M.D., O.B. G.Y.N. "Knowing that difference can set you free from confusion and fear." Prempro and Premarin are synthetic substitutions for hormones. They are not natural hormones that can be safely replaced in the body.

What is the difference between a natural hormone and synthetic hormone?

Natural hormones, sometimes referred to as bio-identical hormones, are hormones that have been scientifically engineered to have the identical molecular structure of the hormones found in the human body. The molecular source of these hormones comes from yams and soybeans. "This is nature's ideal design because the bio-identical hormones are just like the hormones that our bodies are designed to recognize and utilize," says Dr. Christine Northrup, who wrote The Wisdom of Menopause. This means that the effects are more consistent with our normal biochemistry with less chance for unpredictable side effects.

Premarin, which is said by some people to be a natural product, is made from horse urine. As Dr. Joel Hargrove, a pioneer in the use of bio-identical hormones and the medical director of the Menopause Center at Vanderbilt University Medical Center says, "Premarin is a natural hormone if your native food is hay." Equine estrogens aren't normally found in the human body and they are associated with side effects such as headaches, bloating, sore breasts and an increase incidence of breast cancer. The breakdown products in Premarin are so strong that they can produce DNA damage that is carcinogenic in the tissue and thus the increase incidence of breast cancer.

SOURCE/REFERENCE: The Wisdom of Menopause by Christine Northrop, M.D.

The Use of Natural Hormones

Natural Progesterone

The use and benefit of this remarkable hormone has been underrated and underestimated for way too long. Progesterone reduces much discomfort due to typical menopause related changes, balances out any possible side effects while you enjoy the benefits of estrogen replacement, eliminates the problems associated with patented, chemicalized progestin drugs, aids in the body's defense system against cancer, decreases water retention, promotes relaxation and better sleep and helps maintain your proper body weight. It is also beneficial regarding new bone formation, breast cancer prevention and treatment, and cardiovascular disease protection.

Natural Estrogen (estrone, estradiol and estriol)

Estrone, E1. Premarin contains a high percentage (48perscent) of estrone which is identical to what the body makes. Wherein lies the problem, is that it is prescribed to women who do not need it and in excessive doses. After menopause, estrone continues to be made by conversion of the adrenal steroid, androstenediol, mostly in body fat and muscle cells. The more fat, the more estrone is made. Estriol is safer in regard to breast cancer than estrone or estradiol, so rarely is this hormone compounded for use.

Estradial, E2. This hormone is the most stimulating to breast tissue, estrone is second and estriol by far, the least.

Estriol, E3. This hormone is a much safer replacement for estrogen than any other estrogen. In fact, it is not listed in the Physician's Desk Reference (PDR) because pharmaceutical companies do not sell it commercially. Only through a compounding pharmacist can it be obtained. The beauty of this hormone is that it is much safer and has much fewer side effects that estrone and estradiol.

The Use of Androgens

DHEA (dehydroepiandrosterone)

DHEA is an adrenal-produced steroid hormone and is made in the adrenal glands which make up more than 150 hormones. Although DHEA is not an androgen, so to speak, in a woman's body, it can be converted to androstenedione and testosterone. DHEA circulates in blood primarily as DHEAs, a sulfated version.

Men produce more than women and we know that after the age of 25, they produce less. The onset of disease correlates with this decline. In the elderly, higher levels of DHEA mean better health and longer life span. When the elderly are given DHEA supplements. They experience a boost in energy, digestion and immune function.

Androstenedione

Androstenedione is a steroid hormone that is a precursor to testosterone and estrogens. It is secreted from the adrenal glands and ovaries into the bloodstream. It is quite popular with body builders who want to increase their testosterone levels.

Some of the positive effects if androstenedione are the increase of muscle mass, enhanced energy, enhanced libido and a sense of well-being because it converts to testosterone. This hormone can be used first if a testosterone deficiency is determined.

Testosterone

Testosterone is the most important anabolic hormone and women make about a tenth as much as their male counterparts. Testosterone gradually decreases with age. After menopause, the ovaries continue to produce both testosterone and androstenedione. Oftentimes, a low dose of natural testosterone can help to restore the balance of other hormones.

New evidence suggests that prostate cancer is more likely to occur in men with high estradiol and low testosterone levels. Testosterone levels, when maintained at sufficient levels can lower LDL cholesterol, lower triglycerides, raise HDL cholesterol, raise human growth hormone, lower blood pressure and normalize abnormal heart rhythms.

SOURCE/REFERENCE: Preservion, The Natural Hormone Balance by Dr, Uzzi Reiss, O.B./G.Y.N.

Doctors Trivialize Change of Life Symptoms, Menopausal Women Say

Washington , D.C. - A new J.D. Power and Associates survey of menopausal women released on July 28, 2003 found that many women aren't talking about their symptoms with their doctors, who often trivialize symptoms and leave decisions about treatment up to their patients. The survey, commissioned by the National Consumers League (NCL), surveyed more than 800 women not currently taking hormone therapy and found that, as the severity of menopausal symptoms increases, satisfaction levels with doctor-patient relationship decreases. Additionally, women surveyed reported that the perceived physical, emotional and personal impact of symptoms increases along with their severity.

"Women are clearly confused about menopause and their treatment options. Last summer's news of the Women's Health Initiative left millions of menopausal women wondering, 'what should I do about my symptoms?'" said Linda F. Golodner, NCL president. "NCL wanted to learn about the experiences of menopausal women as patients, how their symptoms affect the rest of their lives, and what women are doing about it."

According to the study's findings, nearly one third of the women surveyed said they're not discussing their symptoms with doctors. The Washington-based consumer organization, an advocate for strong doctor-patient dialogue, launched a campaign that will help prepare menopausal women to begin productive discussions with their healthcare professionals.

"Women say they need help, but telling them to talk to their doctors is obviously not enough. Many menopausal women don't even understand what they are going through, so beginning conversations with their doctors about symptoms is impossible," Golodner said. "NCL is trying to change that."

NCL's new national education campaign, MenoPAUSE: Take Time to Talk about Your Symptoms, will provide millions of women who experience menopausal symptoms, particularly those that are moderate to severe, with tools to help them recognize their symptoms, understand the impact they have on daily life, and partner with their doctors to make treatment decisions. At www.nclnet.org/menopause, consumers can download checklists made for assessing symptoms and facilitating productive discussion with healthcare professionals.

"Just as every woman is different, every woman will have her own menopausal experience," said Ann L. Honebrink, M.D., University of Pennsylvania Health System. "Some women have no symptoms, while others will experience frequent, disruptive symptoms. Women need to talk to their doctors not just about the symptoms, but also about how the symptoms affect daily life. Then, they can work together to make appropriate treatment choices."

SOURCE/REFERENCE: The J.D. Power and Associates study and MenoPAUSE are made possible by an unrestricted educational grant from Wyeth. To learn more about MenoPAUSE, visit www.nclnet.org/menopause.

National Consumers League

Founded in 1899, the National Consumers League is America's pioneer consumer organization. The organization's mission is to identify, protect, represent, and advance the economic and social interests of consumers and workers.

J.D. Power and Associates

Headquartered in Westlake Village, Calif., J.D. Power and Associates is an ISO 9001-registered global marketing information services firm operating in key business sectors including market research, forecasting, consulting, training, and customer satisfaction. The firm's quality and satisfaction measurements are based on responses from millions of consumers annually.

Making Your Physician a Natural Hormone Partner

Today's managed care medical environment has made it tougher on a physician's professional life. Besides the stress, pressure, and responsibility involved, doctors face so many hazards on the job that they should probably begin wearing hard hats to work. I don't know a single group of professionals that is more harassed, regulated and unappreciated.

Unless you see an anti aging or preventive medicine specialist, it is unlikely that your doctor will have the knowledge, ability, or time to help you fine-tune your hormones. We live in an age of crisis medicine. Most people go to their doctors with problems and not with the intent to prevent problems.

This is a flawed system, and a flawed emphasis. You only have to look at a few statistics to realize how badly flawed. I'll share three statistics with you here:

*The 1996 University of San Francisco study that found about ninety-nine million Americans suffer from some form of chronic ailment. That's 40 percent of the population.

*Up to two million Americans are hospitalized, and about 100,000 die each year, from the side effects of prescriptions drugs.

*Ninety-nine percent of the government's "health sector budget" is used to treat illness after it occurs. One percent is allocated for prevention, even though the vast majority of chronic illnesses are preventable. Health care reform bills basically deal with who will pay for whose disease and how to streamline disease-care financing and delivery. There's no talk of improving health.

Even against this dismal background, if your physician goes off the beaten path of primarily pharmaceutical and surgical choices, the insurance establishment may not pay for it. And the medical establishment doesn't really like it.

A physician's freedom to choose different techniques or remedies that are not "officially sanctioned" is often quite limited. If he or she chooses "alternatives," there may be a job risk involved, no matter how effective the treatment is and how much it helps patients.

Fortunately, this situation is improving, thanks to a large and growing patient demand for safer and more effective options. In recent years we have seen a huge influx of patients resorting to "alternative" practitioners along with a parallel integration of "alternative" methods by many conventional doctors.

Despite the changing climate, don't be surprised if your interest in natural hormones falls on deaf ears. Most physicians aren't familiar with how natural hormones can help many typical female problems or address aging concerns.

Natural hormones are legal to prescribe and use, and increasing numbers of doctors are recommending them because of their safety and effectiveness. They offer a powerful alternative to "conventional" pharmaceutical hormonal prescriptions that may cause imbalances, side effects and cancer.

You will need prescriptions for estrogen, progesterone, as well as for testosterone and human growth hormone, if you choose to use them.

Compounding pharmacists mix, assemble and package prescriptions to meet the individualized needs of patients. The local pharmacist you may be more familiar with is likely to dispense the manufactured form of a particular medication. Both types of pharmacists are fully licensed.

If you have any questions about balancing your hormones or need to find a physician in your area, please call Nulife Solutions at 941-870-2712.

SOURCE/REFERENCE: The Natural Hormone Balance by Uzzi Reiss, M.D./ O.B.G.Y.N.
Editor: Kristi Bonsack, President ~ NuLife Solutions, LLC ~ 941-870-2712.


Endocrinology and Female Infertility

What Is Infertility and Why Is It a Concern?

Infertility is the inability of a sexually active couple, not using any contraception, to conceive during one year, the time in which about 90 percent of couples succeed. Over their lifetimes, approximately one in every five couples in the United States seek infertility care, resulting in more than 2 million office visits to health care providers each year. Just over half of all infertility is attributable to the female partner.

Infertility is the inability of a sexually active couple, not using any contraception, to conceive during one year, the time in which about 90 percent of couples succeed. Over their lifetimes, approximately one in every five couples in the United States seek infertility care

What Causes Female Infertility?

For pregnancy to occur, several things must happen: an egg must develop and ovulate properly each month, and a sperm must fertilize the ovulated egg. The resulting embryo must be transported to the uterus and implanted.
If any of these events does not occur or is disrupted, infertility will result. Some women are unable to produce eggs. Others produce eggs, but do not ovulate. In others, conception cannot occur due to blockage of the fallopian tubes, scarring of the uterus, or the inability to produce cervical mucous of sufficient quantity or quality. These problems account for just over half of all infertility.

How Is Female Infertility Treated?

Many treatments are available, depending on the cause of the infertility, and it is always important to investigate both partners. Fertility drugs, such as clomiphene citrate or recombinant human FSH (follicle stimulating hormone) may bring about ovulation in women. Insemination directly into the uterus can manage infertility related to problems in the cervical mucous. Blocked fallopian tubes can sometimes be surgically repaired. In-vitro fertilization, also called "test-tube baby" procedures, and related assisted reproductive technologies are the most dramatic treatments for female infertility. Although these techniques may be time-consuming and costly, they offer hope to many women who previously were unable to conceive.

What Is the Role of Endocrinology?

Endocrinologists are experts in the understanding and diagnosis of menstrual cycle problems and infertility. They can help determine the cause of the infertility by performing blood tests and X-rays. Endocrinologists can also provide the necessary treatment to increase the chances of conception.
Endocrine research has been crucial in helping thousands of childless couples have children by determining the precise hormonal imbalance and treating it. However, many of the intricate hormonal changes that determine the successful completion of the reproductive cycle are not yet fully understood and further research is aimed at providing a greater understanding of these processes. It is expected that improved understanding of the reproductive process will help to refine the existing treatments by reducing any associated risks and providing information on which patients will benefit most from a specific treatment approach. In addition, current research is expected to lead to new types of treatment, particularly for those in whom current treatments are ineffective.

Copyright © 2000 The Endocrine Society and The Hormone Foundation

The Hormone Foundation, the public education and outreach affiliate of The Endocrine Society, is an independent, non-profit organization, that seeks to improve the quality of life by promoting the prevention, diagnosis, and treatment of human disease in which hormones play a role. Founded in 1997 by The Endocrine Society, the Foundation strives to educate the public by publishing materials and holding educational forums, seminars, lectures and meetings.Founded in 1916, The Endocrine Society is the world's oldest, largest, and most active organization devoted to research on hormones, and the clinical practice of endocrinology. Today, The Endocrine Society's membership consists of over 9,000 scientists, physicians, educators, nurses and students, in more than 80 countries. Together, these members represent all basic, applied, and clinical interests in endocrinology. The Endocrine Society is based in Bethesda, Maryland. To learn more about the Society, and the field of endocrinology, visit the Society's web site at www.endo-society.org.


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