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Make sure to always give positive reinforcement to your children. If they get good grades or score the winning point, take them...
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| -DrErika |
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 Natural Progesterone Cream
My 'Pro Cream Formula' Natural Progesterone Cream is a topical dietary supplement for women of all ages who experience symptoms relating to PMS, Peri-Menopause or early menopause,and Menopause. |
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| Mary Davenport |
| At the age of 29, my doctor put me on Premarin, subsequent to my total hysterectomy. For the following 20 years of my life, I felt rotten, had very little energy and a general overall loss of interest... |
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| SALIVA TESTING
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This test is a new and easy method of determining free hormone levels. It is performed by few mail order laboratories and the data on the usefulness of this test is largely anecdotal. It is cheap, it isn't invasive, and it can be made available to practically anyone.
According to its proponents, saliva testing offers a good measurement of the amount of hormones circulating in our blood freely at a particular point in time. For the women who are taking hormone supplementation, the saliva test may be a fairly reliable indicator of their bioavailability. The problem with the test is the same as with any other test of hormones- it reflects one point in time and offers no overview of the general status of the hormone balance in your body.
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| 24-HOUR URINE TESTING
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A rarely used test, the 24 hour urine hormone test has been advocated by Jonathan Wright, MD, one of the original proponents of natural hormone therapy. The test is cumbersome, costly and difficult to interpret. Unlike the snapshot approach taken by blood testing, 24 hour urine will reflect how much hormones are excreted through your kidneys in 24 hours. It does not reflect variation of hormone levels with the time of day, an important piece of information when using this test in infertility therapy. Unless the test is performed at short time intervals following or during hormone therapy, its use in menopause is limited.
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| BONE DENSITY
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Bone density studies are important when setting a course for the future. Before taking a bone density test, risk assessment should be the primary mode of screening. If you are small framed and thin and your mother albeit not diagnosed with osteoporosis, was stooped over, you are at high risk.
A baseline bone density test for women over 50 provides information about the thickness of a woman's bones at a critical point when estrogen, the protector from thinning bones, starts to wane. There are quite a number of bone density tests available and it is important to know how reliable they are and what type of information they give you.
For a baseline test in people who have no family history of osteoporosis, don't smoke, who exercise regularly, and are on a bone sparing diet, a simple ultrasound of the heel will do. I personally like the test because it reflects the thickness of a much-stressed bone. Since we are constantly pounding down on our heels, signs of thinning in this bone should lead to more in depth evaluation of the general status of your skeletal system.
Another popular test used by some doctors in their offices, measures the thickness of the middle finger bone. I think the value of this test is questionable because the bone tested is very small and not necessarily representative of the state of your spine or hip or legs, areas where osteoporosis does the earliest and most significant damage.
People with family history of osteoporosis, with poor eating habits, with history of cancer who have had chemotherapy or are taking tamoxifen, or other antiestrogen medications, the bone density test should be a DEXA scan which compares the thickness of your hip, femur or forearm, and spine to what is considered normal for your age group and body configuration.
Following your bone density levels on a yearly basis for women at risk who are taking hormones or medications to improve bone density is a wise choice.
If your bone density was normal as a baseline and you are not at risk genetically, you are taking natural hormones, you're eating well and exercising regularly, it's unnecessary to repeat your bone density level more often than every few years.
A word of caution about bone density testing- this test came into vogue when a pharmaceutical company started making medication specifically aimed at "treating" osteoporosis. Free testing is usually sponsored by the drug manufacturers and the goal may be to find as many women as possible with thinning bones to place them on medications. To date, almost five years since the medication has come to market, there is no data to support the medication's beneficial result in the treatment or prevention of osteoporosis. Diet, exercise and natural hormone supplementation present a much more benign and promising way of protecting ourselves from osteoporosis.
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| CARDIAC STRESS TESTING
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Women over the age of 40 whose hormones are beginning to deplete rapidly catch up with men in incidence of heart disease. Women over 50 have the same incidence of heart disease as men. Heart disease is the number one killer of older women. Until 10 years ago the medical profession seemed totally unaware of this important public health issue.
Cardiac stress testing is a good method to diagnose heart disease long before a woman has a heart attack, as the risk factors increase with age.
The most commonly used stress test is the SESTA Mibi- a treadmill test where the patient receives a radioactive injection which helps visualize the blood vessels of the heart. The test is safe and quite reliable and has been a staple for the testing of men for the past 15 years. A positive or abnormal test is usually followed by an angiography, also known as a coronary arteriography. The angiogram is more invasive, but is not just a diagnostic test. If abnormal, it becomes a therapeutic test and an angioplasty- cleaning out the clogged blood vessels- is often performed at the same time.
The newest test for screening heart problems is the ultrafast CT scan- EBCT. It is a non-invasive test. A CT scan is performed that highlights areas of calcification in the coronary artery system. If the test is positive, the same route as for a regular stress test is followed.
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| MAMMOGRAPHY
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Mammography is a radiologic test used to diagnose breast cancer. It is not a preventive measure. Mammography diagnoses breast cancer once it is there. Mammography does not protect us from getting breast cancer, and it does not prevent breast cancer from growing. I cannot tell you how many patients, myself included, go through weeks if not months of sheer panic before going to have their annual mammograms for fear of getting a positive reading. The more exposed we are to the importance of having yearly mammograms, the more stressed out and paranoid we are becoming about the risk for breast cancer.
The type of tissue that makes up our breasts is the most radiosensitive tissue in the body. Every time we have a mammogram we are exposing it to radiation in the name of protection. If you ask the radiologists, they'll tell you not to worry, the dosage of radiation is very low. However, as a doctor, I feel very uncomfortable that with each passing year, we are ordering more mammograms and we promote the importance of doing the tests without considering the dangers of radiation to the very breasts we are trying to protect.
When I have this conversation with my patients, we quickly discover that we are all confused. We don't want to miss the cancer, but we also don't want to stimulate its potential growth by unnecessary exposure to radiation. Regardless I do have to give direction to the patients I see every day. Not to mention the question what do I do myself?
I have finally achieved a level of comfort with the following compromise.
I suggest a baseline mammogram in all my patients between the ages of 35-40. Following that, I teach patients self-examination as the most important method of early detection. I recommend mammograms every 1-3 years based on family history, environmental risk factors (diet, smoking, profession), and medications (Premarin, tamoxifen, birth control pills) and the presence of persistent lumps.
When I find myself experiencing difficulty making a decision, I use ultrasound to help. Breast ultrasound helps distinguish between solid and hollow masses in the breast. A hollow cyst is less likely to be cancerous than a solid one. When I reach the point where no other doctor- meaning radiologist- will commit, I go for the biopsy of the exact area in question. Stereotactic biopsies (Fine needle aspirations under fluoroscopic guidance) are the only type of biopsy you should allow. The abnormality is identified in the radiology suite by a radiologist, and then under direct visualization, a fine wire is threaded into the area in question for the surgeon to extract.
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| PELVIC ULTRASOUND
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(The Best Test To Follow Results Of Hormone Treatment)
I am amazed how little this incredibly valuable test is being used. Most gynecologists have easy access to ultrasound machines and most radiologic facilities have more than one type of ultrasound machine. Yet, unless you are pregnant, or are being studied for infertility, few women undergo this test as part of routine health maintenance programs.
Without a doubt, in my opinion every woman on hormone supplementation whether natural or synthetic should have annual pelvic ultrasounds. The pelvic ultrasound is an inexpensive, and the information derived from it is priceless. It allows your physician to determine the thickness of the lining of your uterus and visualize the shape and configuration of your ovaries. This method of follow-up is important because hormone supplementation directly affects both your uterus and ovaries. The thickness of the lining of the uterus is directly affected by both estrogen and progesterone. The more estrogen, the thicker the lining- the more progesterone, the thinner. Good balance between the two translates into a normal thickness. Along with the thickness of the lining of the uterus, the ovaries are constantly under the direct effect of hormones.
Ultrasound is the test that provides the information necessary to supervise hormone therapy of any kind.
Ovarian cysts and the use of ultrasound
When a 22 year old goes to a doctor with pain in her lower abdomen, the doctor thinks: ovarian cyst. There are more ultrasounds of the pelvis ordered on young women with belly aches than probably any other test. Why are we so a tune to ovarian cysts in our 20s, and forget about them as we age?
Ovarian cysts do not have to be abnormal. They are common and their presence is not a warning sign of potential disease, or an indication for surgical intervention. In Chapter 2, we talked about the corpus luteum. When we ovulate, the egg is pushed out of the ovary and the corpus luteum grows around it. At the site on the ovary, from where the egg was pushed out, a cyst sometimes develops. The cyst may be hollow, filled with fluid or tissues, and grows or shrinks, under the influence of circulating hormones. Occasionally it becomes large and causes discomfort. Rarely it ruptures and causes severe pain. Most commonly, the cyst disappears before the beginning of the next period. When taking hormones of any type (starting with birth control pills), the ovary often reacts by forming cysts. Ultrasound is the best method of following the evolution of these cysts. The rare times when cysts necessitate surgical intervention is when they become large and painful or when they are diagnosed as tumors (most often benign).
Why use ultrasound in older women?
When hormone therapy is administered, the ovary is stimulated and, sometimes, cysts grow. Most likely they are benign and monitoring them with periodic ultrasounds is an appropriate and safe approach.
Another case of late diagnosis with deadly effects in women over 40 is ovarian cancer.
The easiest way to diagnose ovarian cancer early is to perform routine ultrasounds of women at high risk.
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| CAT SCANNING and MRI
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If an abnormal ultrasound is found the next step is obtaining a CAT scan or and MRI.
These are advanced tests and should not be used routinely. Conventional medicine has developed logical and safe sequential approaches to diagnosing illness. Let your physician guide you there. Our goal is to keep you healthy and prevent illness. CAT scanning and MRIs have no place in the evaluation of healthy people.
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| TESTING REGIMEN FOR THE HORMONE SOLUTION PATIENTS
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Balancing natural hormone supplementation should be based on symptom relief. We do not have accurate guidelines in blood testing to correlate blood levels of hormone balance. Ultrasound is the only test that will show effect of hormones. This does not mean you should forgo testing altogether. Work with your doctor and find the tests that reflect your symptom status and create a blend of subjective and objective guidelines to best suit your individual needs.
To deal with the conflicting information and provide the patients in my practice with safety and good follow-up I advise the following testing regimen:
- A baseline mammogram at 35-40 for women without family history of cancer
- A baseline blood test at the initial visit and then follow-up based on individual needs and symptoms on a bi- yearly or yearly basis
- Stress test for all women over 50
- Pap smear yearly for menstruating women and every other year for women who have stopped their menses.
- Baseline screening heel bone density on women over 40. Repeat at yearly intervals if the family history suggests high risk for osteoporosis
- Ultrasound of the pelvis at the initial evaluation and yearly for all patients on hormone supplementation.
- Baseline colonoscopy for women over 50 with no family history of colon cancer.
Adapted from The Hormone Solution by Erika Schwartz, M.D. Buy the complete book for $13.99 including postage.
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