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Ellen Dolgen

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  • Wash Menopause Right out of Your Hair

    Posted on Monday, November 17, 2014

    http://www.shmirshky.com/wp-content/uploads/2014/02/Ellen_Dolgen_Menopause_Monday.jpgSo, you've soldiered through the hot flashes and weight gain associated with menopause for months and just when you thought you were on top of things, things on top become your new focus. Menopausal-related hair loss can come as a big surprise...and not necessarily one that'll leave you smiling.


    As you travel through menopause, your hair has a tendency to pack its bags and go away leaving you with a receding hairline, widening part and maybe even some tiny patches on your scalp. Couple this with the multitude of new coarse hair growing on your lip and chin and suddenly you're seriously wondering how to cope.


    Your hair has long been a critical 'supporting character' in your life story. That's why when you first notice shedding on your brush, followed by hair going down the drain, it can be devastating.


    Bad Hair Days


    Dr. Nicole Rogers, prominent hair transplant surgeon and board-certified dermatologist says this menopausal hair loss can be traced back to the same thing that triggers many menopausal symptoms: fluctuating hormones.


    "As estrogen levels drop, normal circulating levels of androgens might be unmasked. This can translate to unwanted facial and chin hairs, as well as hair thinning for some women," explains Dr. Rogers.


    "Female hair appears as a localized thinning the front portion of the scalp, or can occur diffusely over the entire scalp."


    This 'diffuse generalized hair loss' is present in 26% of post-menopausal women over the age of 45, according to the British Association of Dermatologists' study. That includes hair not just on the top of your head, but also near what they term 'androgen-sensitive sites,' or the hair 'down there.' It thins out, too, even as facial hair gain takes root in most women: 40% attested to that in this particular study. So, in essence, thick hair where you don't want it and thinning where you want the hair to stay put and grow.


    Hormones and Diet Play a Part in Hair Loss


    Normal aging is associated with hair loss and skin pigmentation changes, according to at least one study that also states that administering estrogen might delay skin aging. However, Dr. Rogers believes that relying on hormone replacement therapy or HRT to help reverse hair thinning is still not a proven antidote.


    "Some patients have told me anecdotally that taking hormones seems to help; however, the use of HRT to treat hair loss has not been well-studied."


    Sluggish thyroids that control metabolism, body temperature and weight can also be to blame for hair loss. Many of the symptoms of menopause are similar to a thyroid condition and that can be confirmed with a thyroid blood test panel under a physician's care.


    Finally, diet and stress do play a role in hair loss, particularly your body's levels of zinc and iron. Iron deficiency, is being researched as a factor in hair loss and in one study, 22.7% of the tested premenopausal women low on iron had greater hair loss.


    Heir Apparent


    As the old saying goes, 'if you want to know what a woman will look like when she's older, look at her mother.' Do genetics play a role in thinning hair, as well? According to Dr. Rogers, it does.


    "If you have a relative who is bald, wears a wig, had a hair transplant or uses camouflage, then there is probably a gene for hair thinning that runs in the family."


    "If women are genetically programmed to develop female pattern hair loss, this can develop as early as the teen years or as late as the post-menopausal period." says Dr. Rogers.


    I Have to Do Something with My Hair!


    If you've ever caught a glimpse of your reflection unexpectedly, it can reveal new things about your appearance. If that happens to be a receding hairline or patches of scalp, what can you do? Don't panic.


    Right now, the only FDA approved medication for hair loss is topical Minoxidil, which comes as a 2% solution for twice-daily use in women, according to Dr. Rogers.


    "The FDA did approve 5% Rogaine Foam for once-daily use in women, but it is not being sold in stores yet."


    "Women may also use various low-level light therapy devices such as the HairMax Lasercomb, which has FDA clearance to treat hair loss."


    There is always a hair transplant, which moves hair follicular units from other parts of your body to your head, but it is expensive.


    It's only hair!


    We know how important our hair is to our overall self-esteem. Turns out, scientists even agree, having conducted studies on how wisdom helps us nurture deeper feelings of self-esteem and a positive spirit. If you find that you are experiencing sudden hair loss, be sure to see your physician. In the meantime, get creative with a new fun style that can make your hair loss less noticeable.


    Make it a fun shopping trip and discover what's out there in the way of cute accessories and even hair extension. They'll add lift and length in the time it takes you to smile and greet the day with renewed confidence. It is not exactly "modern medicine", but today we have access to hair extensions, clip-ons, scalp camouflages, and oodles of accessories that can add the appearance of length and fullness without anyone knowing.



    Suffering in Silence is Out! Reaching Out is In!


    0 Replies
  • Couples Counselor Shares Secrets to a Happy Relationship

    Posted on Monday, November 10, 2014

    http://www.shmirshky.com/wp-content/uploads/2014/02/Ellen_Dolgen_Menopause_Monday.jpgMy husband, David, and I have been married 37 years. What's the secret to the longevity of our relationship? I'm no expert, but I know I have never stopped dating David! We are still in love and enjoy being with each other.


    Naomi Gauthier Berry, however, is an expert. This past summer I chatted with Berry, a dear friend who's an individual and couples counselor, to get some tips on how to maintain the spark in your relationship.


    No matter what stage of life you're in (including perimenopause and menopause!), what type of relationship you're in or how long you've been with your partner, your relationship is certain to have its ups and downs.


    Show gratitude


    So how do you balance the teeter-totter of your relationship? One way is to be grateful for each other. A study published in the Journal of Personality and Social Psychology found that couples enjoy higher relationship satisfaction when they feel thankful for their partners. Some claim that this simple practice of gratitude helps remind couples what it is that they love about their partner. I asked Berry to share her perspective on this and other issues regarding relationships.


    "Developing an attitude of gratitude is one of the most effective ways to cultivate and maintain a healthy relationship," she said. "For most couples, this is easy to do in the beginning stages of a relationship. All relationships progress through stages. For the first six months and up to two years, couples are in the infatuation stage."


    During this stage, Berry said that hormones are surging (oh joy!). She added that couples tend to idealize their partners, focusing on their partner's good qualities.


    Friendship is important


    Drs. John and Julie Gottman have done extensive research on what makes marriages thrive. The relationship experts found that the most significant factor that determines whether couples stay together is the quality of the couple's friendship.


    Negativity is a no-no


    The trick to maintaining a healthy relationship, Berry said, is to keep negativity at bay. This can be done by avoiding what Dr. William Glasser, father of Choice Theory, coined as "Deadly Relationship Habits." These include:


    • Criticism

    • Complaining

    • Nagging

    • Blaming

    • Threatening

    • Punishing


    Happy couples habitually and consciously practice "Caring Habits." These include:


    • Listening

    • Accepting

    • Supporting

    • Encouraging

    • Respecting

    • Trusting

    • Negotiating differences


    If you feel you're guilty of engaging in "Deadly Relationship Habits" (and we've all done so), don't worry. Berry said that it's probably something you've been doing unconsciously. Recognizing your tendency to use deadly habits is the first step toward changing your behavior.


    The lowdown on low libido


    I had to ask the next question, since many menopausal women suffer from a lack of libido: Do you find that intimacy wanes as couples get older, especially as women enter menopause? What kind of "homework" do you recommend?


    Sexual intimacy can change for a couple as women enter menopause. Both men and women experience changes in libido and sexual functioning as they age. Berry reminds us, however, that intimacy is so much more than sex. Intimacy does not have to wane as couples grow older. It is not uncommon for couples to become so connected to their significant other that they often forget there are differences between them and their partner.


    "For example, you may have a stronger need for freedom than your husband and therefore; need more alone time than he does. People are naturally inclined to give their partner what they themselves want instead of what their partner may prefer. Gaining an understanding of your partner's needs and making a concerted, meaningful, and long term effort to meet your partner's needs is critical for nurturing and growing a healthy relationship," said Berry.


    While my husband and I enjoy each other's company, we are, however, two different people. I think if I were married to myself, I would be bored to tears! We have the same character, but we come to the table from a different perspective and work together with mutual respect. David does not complete me. I do not complete him. I asked Berry: How can two people maintain their own identity and still function as a healthy couple? Can you love your partner without losing yourself?


    True love


    Berry commented on my long marriage to David: "37 years – Congrats! Over those 37 years, you and David have changed significantly and at different stages of your relationship. The one constant for a healthy relationship is to love yourself unconditionally. The question is not, 'Can you love your partner without losing yourself?' but rather, 'Can you love yourself and not lose your partner?'"


    Why the breakup?


    If a relationship does deteriorate, as many do, I asked Berry if she could point to one reason that could be the single most contributing factor that breaks apart relationships. As I expected, she said there are many theories as to why couples tend to drift apart over time including things such as a lack of common interests or frequent conflict.


    For the widowed: Loneliness vs. being alone


    Some relationships end when one partner passes away. Many people find it extremely difficult to move on. Berry explained that the long-term widowed partner will likely go through a grieving process, which can take time. "One way that I help individuals process the loss of a partner is to help them reframe their feelings of 'loneliness' into 'being alone.' I do not recommend moving on to another relationship until you are comfortable being alone. Once you are, you're much less likely to attract the wrong person into your life."


    Berry's tips for a long-lasting relationship:


    • Be present when you're with your partner.

    • Treat your partner like you would treat your best friend.

    • Remember you can only control your half of the relationship.

    • Practice the Platinum Rule: "Do unto others as they would have you do unto them."

    • Love yourself unconditionally.

    • Create quality time and make your relationship a priority.

    • Make a conscious effort not to focus on your partner's imperfections and instead choose to notice and celebrate your partner's positive qualities.

    • Create quality time and make your relationship a priority.


    The cure for a stale marriage? Take two tips, and call me in the morning.


    Suffering in silence is OUT! Reaching out is IN!


    0 Replies
  • The Holidays Menopause = Stress3

    Posted on Monday, November 3, 2014

    http://www.shmirshky.com/wp-content/uploads/2014/02/Ellen_Dolgen_Menopause_Monday.jpgIt's a mathematical fact: Your level of stress is inversely proportional to the proximity of the holidays. As the days between now and the holidays decrease, your stress level is certain to increase. It doesn't matter whether you celebrate Christmas, Hanukkah, Kwanzaa or another holiday.


    Stress is stress.


    We're deciding what to cook/which cookies to bake and how much/many, whom to invite (or not), when to hold the event, whether invitations are necessary, how to decorate, what to wear, where out-of-town family members will sleep, who's at the children's table, etc., etc.


    Sigh.


    One thing that we don't plan for, is the stress that surrounds holiday time. Unfortunately, women are more susceptible to holiday stress than their male counterparts. During this time of year there's also often more stress at work, which is compounded with the seasonal rush to find the time to get everything done.


    Add to the holiday hubbub all the haywire hormones of perimenopause or menopause, and you'll need to call in the troops. Here's some ammunition you can add to your pre-holiday arsenal:


    Strategize


    Don't overspend. I say "Bah, humbug!" to the commercialism of the season. You shouldn't feel pressured to spend a lot of money. When it comes to gift giving, start saving early. Set a budget. Find non-monetary gifts to give to the special people in your life (a weekend of babysitting for a relative, for example). The gift of your time is the best gift


    Go easy on yourself. Divide your projects into smaller tasks. For instance, don't try to decorate the entire house in one day. Start with the tree, or your mantle. You won't be so overwhelmed if you break up the tasks.


    Surround yourself with reinforcements


    Don't go it alone. Enlist the support of your family and friends. By including your children in the holiday preparations, you'll give yourself a break and ensure that they carry on favorite family traditions for years to come. If you're planning a really big gathering, think about hiring some professional help with either the cooking or the cleanup – or both. That way, you'll actually be able to enjoy spending time with friends and family.


    Make a truce with tradition


    Don't be a stickler for tradition. Just because you've done things the same way for decades, doesn't mean you can't change them now. I'm not saying you should abandon tradition. But be open to the idea of creating new traditions that fit with your current lifestyle. Shortcuts can take a lot of pressure off of you and no one will even notice. For instance, if you simply don't have time to bake cookies from scratch, use a mix or even the refrigerator slice-and-bake cookies. (I'll never tell. You can even mess up the edges a bit so they don't look so cookie-cutter perfect!)


    Surround yourself with reinforcements


    Don't fall victim to depression. In addition to being a stressful time, the holidays also can be a lonely time for many. Try to surround yourself with family, friends or co-workers who care about your wellbeing.


    But don't overdo it. While the holidays are the perfect time to socialize, don't feel obligated to accept every invitation. Allow yourself some downtime to recharge and re-energize.


    Don't raid the refrigerator


    Don't surrender to your food cravings. They could be just a result of all the stress.


    It's easy to binge during the holidays, especially when you constantly seem to be around food. Keep healthy snacks on hand. Stock the fridge with cut-up veggies and fruit so you can grab and go if you're crunched for time. Make it just as easy to reach in the fridge as it is to reach in the cookie jar, and you've won half the battle.


    Declare a ceasefire


    Do take a break. Put down the gift wrap, the cookie sheet, the tangled tinsel and take a deep breath. Take a half hour to exercise. Releasing those endorphins may be just what you need. I find 20 minutes of meditation to be quite calming. You can raise the white flag... and raise a glass of wine or your fav eggnog to your lips. Enjoy a little R&R. There are lots of choices to help you say goodbye to seasonal stress.


    Be sure to practice moderation. Excessive alcohol (or even caffeine), can produce the opposite of the intended effect, and actually exacerbate anxiety.


    We tend to be very hard on ourselves. It's time to eliminate the pressure and lower the bar, along with our expectations. To be honest, no one really cares if your soufflé is perfect. Focus instead on what's really important: spending time with loved ones and creating holiday memories to last a lifetime.


    This holiday season, your home doesn't have to be a war zone. You can win the war on stress. All it takes is a little planning, and you'll be able to put the peace back in your holiday planning – and in your holiday.


    Suffering in silence is OUT! Reaching out is IN!


    0 Replies
  • Why You Shouldn't Let Menopause Symptoms Scare You

    Posted on Monday, October 27, 2014

    http://www.shmirshky.com/wp-content/uploads/2014/02/Ellen_Dolgen_Menopause_Monday.jpgAt Halloween time, you might be afraid you'll eat all the Halloween candy before you hear your doorbell ring and that first chorus of "Trick or treat!" For many menopausal women, that's the least of their fears! You and your family may be afraid that your menopausal symptoms are the sign of something more serious... or that they're here to stay for good. Talk about scary!


    The good news is that neither is true. In most cases, your menopausal symptoms are simply the side effects that come with the change of life. And, while they may seem never-ending, there is a way out of "The Little Hormones of Horrors."


    Take a look at the symptoms I've listed in my Menopause Symptoms Chart, and see how you can demystify them to give yourself a little less trick and a little more treat.


    The menses monster


    If you're one of those women whose period was so regular you could set your clock to it, fuhgeddaboutit. And if your cramps were a mere blip, you could be in store for some bleepin' cramps.


    In perimenopause, you're likely to experience anything from spotting to lighter or heavier periods. You may even have some breakthrough bleeding (between cycles, whatever that may be). While a range of flow is normal, report any extremely unusual bleeding to (think "Texas Chainsaw Massacre") your menopause specialist.


    You may have Freddy Krueger-style cramps, or no discomfort whatsoever. Just as women's periods differ greatly before menopause, their menses symptoms will differ greatly during perimenopause and menopause.


    And, of course, you'll miss (as in skip) periods. The time between periods will become greater and greater until you've been without a period for a year, signaling their end.


    Fear and loathing


    Misplacing your keys or your reading glasses doesn't mean you're doomed to get Alzheimer's. As we age, our memory begins to fail us (along with the rest of our faculties — but that's a whole other story). During menopause, though, memory lapses are quite common. If you find yourself saying, "Why are there kids in costumes at my front door?" then this is for you! You can try staving off age-related memory issues by brandishing a cross, but you're better off doing brain exercises. Think of it as mental push-ups. (I know, you're thinking your tatas could use a push-up, too.)


    You also might be overly sensitive, experience uncontrollable crying, be unusually


    depressed or withdrawn, super stressed out, anxious or overwhelmed by it all. Again, this too shall pass. Of course, if your mood swings are more like Dr. Jekyll and Mr. Hyde, see your menopause specialist.


    On the other hand, you might be extremely irritable (aka witchy woman), angry or even violent. I advise you to let your family know how you are feeling. This way, they won't personalize your mood swings. Remind your loved ones that it's the hormones, not them!


    To top it all off, you may find that your libido has gone AWOL. Don't let perimenopause/menopause spook your sex life. Turn spook into spark. Communicate with your partner — and your doctor — on ways to reclaim your sex drive.


    Heart palpitations (and not just when you're in the haunted house)


    Crying and migraines and bloating. Oh my! The list of physical symptoms during menopause is as long as the lines for haunted hay ride: headaches, hot flashes, hair loss and heart palpitations... bloating, breast tenderness and being exhausted... packing on the pounds and perennial peeing... vaginal discharge, dryness and difficulty reaching orgasm. They may be a bit scary, to put it lightly, but they're definitely not life threatening. If certain symptoms (like lack of sleep) are impacting your ability to function, then it's time to call your menopause specialist.


    Find a menopause specialist and you will no longer have to be spooked by perimenopause and menopause.


    Suffering in silence is OUT! Reaching out is IN!



    0 Replies
  • Pelvic Exams--They are A’changin’

    Posted on Monday, October 20, 2014

    http://www.shmirshky.com/wp-content/uploads/2014/02/Ellen_Dolgen_Menopause_Monday.jpgMost of you are used to getting a Pap smear during your annual visit to the gynecologist, but now some health authorities are recommending the age-old Pap be replaced by a new test designed to detect cervical cell abnormalities just about the time they start up.


    So, although the Pap test, which has been the gold standard for diagnosing cervical cancer since the 1950's is still around, there might be something new on the horizon. You might be asking yourself, 'why,' since the National Cancer Institute says the Pap, named after Greek doctor Georgios Papanikolaou, has helped reduce certain cervical cancers by up to 80%.


    The NCCC (National Cervical Cancer Coalition) says that cervical cancer is very preventable and in fact can be prevented through early diagnosis and appropriate treatment of certain cells that become abnormal when impacted by the human papillomavirus (HPV); this is a process which begins long before the actual cancer develops. The Pap has been the topline test for HPV, but there are other, perhaps even better, options to spot the troublesome cells in women starting at an earlier age, according to one government agency.


    The FDA has recommended a replacement screen to detect gynecological cancers, suggesting that the Pap is soon to become a thing of the past. Does this mean that the days of lying on your back, scooting your bottom down to the end of the table, putting your feet in stirrups and waiting for the swab might be coming to a close? Not necessarily.


    The "Quiet Virus"


    Physicians have known for some time that there is a critical link between cervical cancer and the human papilloma virus (HPV), which is transmitted via sexual intimacy and has a tendency to hang around like a bad boyfriend.


    HPV is not very common after the age of 30, but if you test positive for this virus, you may have gotten it many years before and your immune system is still showing positive. HPV causes changes at the cellular level only after it's invaded and been in your system for a while. That is why testing after age 30 is beneficial.


    Recently, the FDA issued guidelines indicating the agency is ready to recognize the Roche HPV DNA test as the frontline check for women over the age of 25. According to the FDA, this specialized DNA test provides not only a current snapshot of the health of your cervix, which is located at the bottom of your uterus, but also provides important information about your risk for developing cervical cancer in the future. It works by detecting DNA from 14 high-risk HPV types, identifying HPV 16 and 18, as well as 12 other types of high-risk HPVs. Doctors get the DNA by swabbing your cervix, much like the traditional Pap.


    If you test positive for HPV 16 or 18, the agency recommends a colposcopy, which lights up and magnifies your cervix, so that your doctor can more closely observe what's going on with your cervical cells. If you test positive for one of the other types of HPV, then it's recommended you have a Pap test to determine your need for the colposcopy.


    One study, the ATHENA (Addressing the Need for Advanced HPV Diagnostics) found that taking a random biopsy at the time of the colposcopy was even more effective in detecting cervical cancer, whether there were visible lesions, or not. In other words, the Pap smear might become just a part of, and not the centerpiece of, your annual pelvic exam.


    But Wait—There's More


    Now several groups of physicians believe that bimanual palpation of your uterus and internal organs (when your doctor inserts two fingers and feels around your abdominal area) is not only unnecessary in most cases but also intrusive enough to cause some patients anxiety.


    This past summer, the American College of Physicians (ACP) came out against routine pelvic exams which involve bimanual palpation, but only in women who are not at high risk for certain cancers, such as uterine or ovarian and those who are not pregnant, because the organization says this particular exam is not effective in detecting cervical cancers.


    Those same guidelines do recommend regular exams of the cervix such as Pap smears because the Pap is still very effective in detecting cervical cancer in early stages. However, the actual exam during which your doctor inserts two fingers into your vagina and checks the abdomen is not necessary, with ACP co-author Dr. Linda Humphrey stating specifically that it, "Rarely detects important disease and does not reduce mortality and is associate with discomfort for many women, false positive and negative examinations, and extra cost."


    The ACP, which is the second largest physician group in the country, agreed that the diagnostic accuracy for detecting cancers utilizing this method is very low.


    The American Congress of Gynecology and Obstetrics (ACOG) had a varying viewpoint insisting that women should continue to get annual pelvic exams including bimanual palpitation, but acknowledged that the decision to include all components of the exam rested with both the patient and her physician. ACOG, the leading group of physicians providing healthcare for women, says these 'well-woman visits' are an important part of the patient physician relationship and along with breast exams, immunizations and contraceptive care discussions help nurture that relationship and ensuing trust.


    I chatted with Dr. Rebecca C. Brightman, assistant clinical professor OBGYN and Reproductive Science at the Mount Sinai School of Medicine in New York City, who says, "It is very important for women to realize that the Pap smear is only a portion of the annual gynecologic examination. An annual (and for some patients semiannual) evaluation of a woman's thyroid, breasts and pelvic organs remains essential."


    Dr. Brightman also notes that for some women, their OBGYN might be the one and only healthcare provider. She further explains, "As an OBGYN, we frequently screen for and diagnose other medical conditions. Women confide in their OBGYNs and seek advice in many areas from mental health concerns to social problems. So, it's way more than just a pap smear!"


    Once again, the patient-doctor relationship is so important to a healthier you!


    Which Way Should You Go?


    Like anything else in life, it pays to be informed about your own gynecological health, although it can be difficult to find a blanket one-size-fits-all answer. Some experts say that if you are a woman with an average risk of cervical cancer, then this is the route to follow:


    • Ages 21 to 29: a Pap smear once every 3 years

    • Ages 30 to 65: Pap smear every 3 years or/combination Pap smear and HPV test every 5 years

    • Over age 65: routine Pap screening not needed if recent tests have been normal.




    Bottom line—it's all up to you whether you'll stick with just the Pap or ask for the HPV diagnostics, as well.


    As always, check with your doctor and reach a collaborative decision. It's the best approach to feeling good and staying healthy, all the way through the 'change.


    Suffering in Silence is Out! Reaching Out is In!


    0 Replies
  • HRT and Your Heart Can Be Soulmates

    Posted on Monday, October 13, 2014

    http://www.shmirshky.com/wp-content/uploads/2014/02/Ellen_Dolgen_Menopause_Monday.jpgMenopause is not for weaklings. Dealing with symptoms is at the top of the list, especially with hormones sending you on a wild ride. Hot flashes, insomnia and foggy brain are but a few and just when you make up your mind to explore hormone replacement therapy, you read about possible effects on your heart.


    Many of you know that heart disease is the number-one killer of women in the U.S. and that might have you wondering what impact HRT will have on your own cardiovascular health.


    Like many things in life—it' all about timing.


    Put Your Heart Into It


    In 2010, the National Institute of Health released results of a 15-year study called the Women's Health Initiative, which addressed cardiovascular disease, osteoporosis and cancer as it relates to menopausal women on hormone replacement therapy or HRT.


    That study discovered that replacement hormones might elevate the risks of stroke and heart attacks in older women. However, most of the study's participants were long past the start of menopause, or their last period. Why is that important? Because conversely, women who go on HRT within four years after their last period do not generally suffer negative effects on their cardiovascular system, according by Dr. S. Mitchell Harman, director of the Kronos Longevity Research Institute. He was the lead investigator for the KEEPS (Kronos Early Estrogen Prevention Study) that examined whether starting HRT sooner after the onset of menopause reduces the risks of cardiovascular disease and also whether there is a difference between oral and transdermal application of the hormones.


    Dr. Harman discovered:


    • Neither transdermal nor oral estrogen treatment significantly accelerates or decelerates rate of change of carotid artery intimal medial thickness (CIMT) in healthy recently menopausal women.

    • Both estrogen treatments have some potentially beneficial effects on markers of CVD risk, but these differ depending on the route of estrogen delivery with improvements in LDL and HDL cholesterol seen with oral and reduced insulin resistance with transdermal.

    • No significant effects were observed on rate of accumulation of coronary artery calcium.

    • Women reported significant relief of vasomotor hot flash symptoms with either form of estrogen


     Dr. Harman stated post-study that, "Four years of estrogen treatment in healthy recently menopausal women is unlikely to worsen risk of cardiovascular events and is therefore a relatively safe strategy for relief of menopausal symptoms."


    Different Points of View


    Dr. Joseph Raffaele, formerly a clinical assistant president of medicine at Dartmouth Medical School and co-founder of the PhysioAge Medical Group, believes KEEPS is a good start, but that much more research is in order. He points out that just a tiny percentage of the women in the study had any significant coronary calcium at all: 85% of the women had a coronary calcium score of 'zero.' The 15% who did have calcium buildup showed an improvement with both the estrogen and estradiol treatments.


    "The problem with the WHI study was that its 16,000 subjects were on average too old and too unhealthy to provide meaningful answers to women considering hormone replacement as they enter menopause," says Dr. Raffaele in a recent blog.


    "The problem with KEEPS was the opposite: its subjects were on the whole too young and too healthy (to show significant improvement), especially for a study that only lasted four years. The researchers should have either used a broader cross-section of subjects or made the study much longer to measure how hormone replacement affects measures of atherosclerosis."


    "KEEPS was not worthless," says Dr. Raffaele, "The news of the announcement focused on the positives: that hormone replacement safely improves menopausal symptoms including hot flashes and night sweats, depression, diminished libido and bone density."


    "That's reassuring to women and should help continue to reverse the decade-long misinterpretation of the WHI data that led many physicians to advise against HRT."


    However, Dr. Raffaele says additional research should include a base of at least 5,000 subjects of varying ages and baseline cardiovascular health, and that those women should be followed for 10 years.


    This opinion is echoed by Dr. Josh Trutt who says, "In the WHI trial, the women were NOT recently menopausal and were at relatively higher cardiovascular risk: on average 62.5 years old and either overweight or with high blood pressure. The women in KEEPS are a decade younger and overall healthier, and on estrogen for a shorter time period. It would have taken a very powerful effect to show a benefit in this group."


    Dr. Raffaele points out that just a week after being disappointed by the KEEPS trial report, a new Danish study demonstrated very positive results for recently menopausal women who went on long term HRT. The study appeared in the British Medical Journal. He further explained that in healthy women (such as KEEPS studied) you need to follow them for a longer period of time to show benefit. The Danish study followed them for over ten years. This is key to answering the question KEEPS couldn't answer: Does taking HRT in early menopause decrease the likelihood of developing cardiovascular disease? The answer is a resounding 'yes.' These Danish women had over a 50 percent reduction in combined heart attacks, heart failure and death. Remarkably this reduction started to accrue very soon after initiation of therapy. The cardiovascular benefit occurred without any increase in cancers of any type, including breast cancer for which there was a non-significant reduction in comparison to placebo. Nor was there a significant increase in blood clots or pulmonary emboli."


    However, Dr. Raffaele does point out that the study used 2 mg of oral estradiol, a relatively high dose, and a progestin that is not commonly used in the US for HRT. This study didn't compare different types of estrogens or routes of delivery: for example, whether transdermal estradiol instead of oral, or micronized progesterone instead of norethisterone acetate, would have had better or worse effects on cardiovascular disease or cancer.


    After My Own Heart...


    Where does that leave you? Consider your options; discuss HRT with your menopause specialist taking into account your own personal health background. This will help you and your specialist weigh the risks and benefits to fit your personal needs.


    With a family history of heart disease, I went on bioidentical HRT early in my menopausal journey. My sleepless nights and brain fog went away in a hot flash! My vaginal dryness and crashing libido resolved. All the numbers in my Lipid Panel are normal and my calcium deposit score is 0. HRT restored my feeling of well-being and I know in my heart of hearts that this was just what I needed to do!


    Suffering in Silence is Out! Reaching Out is In!


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