• Risks:
• Possible Increased Risk of Breast Cancer

*Women with an intact uterus should also take progesterone to prevent cancer of the uterus. "

WHERE TO FIND INFO

National Institute on Aging Information Center
P.O. Box 8057
Gaithersburg, MD 20898
800-222-2225
M - F 8:30 - 5 EST
800-222-4225 (TDD)

Call or write to obtain Menopause, with drawings and quotes from women. Also available: free fact sheets called "Age Pages" on a variety of topics.

Ask for the following:

Managing Menopause, a brief discussion of what to expect during menopause and information on hormone replacement therapy.

Should You Take Estrogen?, a pamphlet on estrogen replacement therapy covering how it is taken, risks and side effects, and who is a candidate for the therapy.

THE HORMONE LIST

Read more about Your Hormones

DHEA is one of several natural hormones that decline as we get older and whose replacement might help the body age better. Doctors prescribing "youth preservation" therapy most commonly recommend the following hormones:

HUMAN GROWTH HORMONE

When it declines: Gradually after middle age.

What replacement can do: Can cause a dramatic shift in the body's metabolism, resulting in more muscle and less fat; accelerates healing in surgical patients; and helps people get more deep sleep.

Side effects: May lead to carpal tunnel syndrome--a disabling condition often associated with repetitive hand movements. Can bring on diabetes-like symptoms and may cause gynecomastia, in which men grow enlarged, tender breasts.

How to get it: Few doctors will prescribe hgh as an anti-aging treatment. Must be injected twice a day at an average cost of $800 a month.

ESTROGEN

When it declines: Gradually in women, starting at age 40; sharply around age 50, leading to menopause.

What replacement can do: Eliminates hot flashes, sleeplessness, and other symptoms of menopause. May reduce the risk of heart disease and osteoporosis in postmenopausal women.

Side effects: Cramping, breast pain, weight gain. Some studies suggest that estrogen therapy may increase the risk of breast cancer.

How to get it: Virtually all doctors will prescribe; women who have not had a hysterectomy will be advised to take a combination of estrogen and progesterone. Pills cost from $10 to $30 a month. Estrogen alone is available by transdermal patch for about $25 a month.

TESTOSTERONE

When it declines: Gradually in men, starting at 40; in women, at 50.

What replacement can do: Increases output of growth hormone and, with exercise, strengthens upper-body muscles. Can improve mood and increase sex drive in older men and women.

Side effects: May decrease HDL, or "good" cholesterol, and boost LDL, the "bad" kind,increasing the risk of heart disease or stroke. By stimulating growth of prostate cells, may increase the risk of prostate cancer.

How to get it: Doctors have begun prescribing it to both men and women for low libido and for some conditions that cause impotence in men. Available by pill, shot, implant, or patch for $50 to $100 a month.

MELATONIN

When it declines: Sharply at adolescence, then again at about age 40; elderly adults produce only half as much as children.

What replacement can do: Eases insomnia in older adults. Animal studies suggest it may strengthen the immune system and fight cancer.

Side effects: Possible lingering grogginess; could worsen pre-existing depression.

How to get it: Not approved by the Food and Drug Administration, but sold in health food stores for $10 to $20 a bottle. Reference: Health Magazine

MENO_ STUFF ON ENDOMETRIOSIS

Endometriosis is the growth of tissue from the lining (endometrium) of the uterus outside of the uterus, in the abdominal cavity. There are various theories to explain what causes this. One is retrograde menstruation, or a backward flow of menstrual fluid through the fallopian tubes, from which the menstrual fluid may be drawn into the ovaries or escape into the pelvic cavity. Retrograde menstruation may prevent the immune system from ridding the body of the wandering endometrial cells by, in effect, creating too much work for the system.

Endometriosis may run in families, since researchers have found that women whose mother or sisters have the disorder are more likely to have it themselves. In some women it causes no symptoms; others report painful periods, pain during intercourse, and sometimes infertility. Most cases are treatable with medication or surgery, but if the disease is severe, removal of the uterus and ovaries through hysterectomy may be necessary.

Uterine fibroids, also called myomas or leiomyomas, are masses formed from the smooth muscle tissue of the uterus and sometimes the cervix. Fibroids usually develop during a woman's thirties and forties and then shrink after menopause. Some fibroids require no treatment, but if they cause heavy uterine bleeding, pain, infertility, miscarriage, or premature birth, they should be removed. After removal, there is the chance that new fibroids will develop. The cause of fibroids is unknown, but their growth seems to depend on the presence of estrogen. Heredity may be a factor.

WHO TO CALL:

• National Institute of Child Health and Human Development
  P.O. Box 29111
  Washington, D.C. 20048
  301-496-5133
  M - F 9 - 5 EST
  

  Provides brochures and packets containing journal and newspaper articles, plus book excerpts on various topics.

  Ask for the following:

• The brochure Facts about Endometriosis
  
• A packet of photocopies of the following articles:
  
• Management of Fibroids
  
• Treating Uterine Fibroids with GnRH Agonists
  
• Fibroids in the Uterus
  
• Sex after Hysterectomy
  
• Plus the chapter on fibroids from 'Understanding Your Body: Every Woman's Guide to a lifetime of health.'

ALTERNATIVE_ WHERE TO FIND __?

Most physicians we see aren't knowledgeable about alternative treatments, so here's a list of contacts to assist you in exploring other options besides those provided by traditional western medicine. These contacts, coupled with numerous others in Power Surge's "September" Newsletter [XIV] should be helpful.

American Menopause Foundation, Inc. operates a national network of support groups that deal with alternative treatments, among other issues. Call (212) 475-3107 for information on a group in your area, or write the foundation at Madison Square Station, P. O. Box 2013, New York, NY 10010.

The North American Menopause Society offers a mainstream perspective on menopause treatment, with lists of suggested readings and physicians in your area specializing in menopause. Write c/o Department of OB/GYN, University Hospitals of Cleveland, 11100 Euclid Ave., Cleveland OH 44106.

American Holistic Medical Association publishes a national referral directory of medical doctors who use alternative treatments. Send $5, check or money order, to 4101 Lake Boone Trail, Ste. 201, Raleigh, NC 27607.

American Association of Naturopathic Physicians offers a list of licensed naturopaths around the country. Send $5, check or money order, to 2366 Eastlake Ave. East, Ste. 322, Seattle, WA 98102. Or call (206) 323-7610.

The Herb Research Foundation will supply information packets on specific herbs for $7 each. For a free brochure, write 1007 Pearl St., Ste. 200, Boulder, CO 80302. Or call (303) 449-2265.

National Center for Homeopathy provides a nationwide directory of practitioners and homeopathy study groups. Send $6, check or money order, to 801 North Fairfax St., Ste. 306, Alexandria, VA 22314. Or call (703) 548-7790.

Transitions for Health has a free mail-order catalog of natural health-care products for menopausal women. Write 621 Southwest Alder, Ste. 900, Portland, OR 97205. Or call (800) 888-6814.

Wellspring for Women offers phone consultations with licensed nurse practitioners who can answer questions about herbal remedies and natural hormones, and put you in touch with doctors who can prescribe them; they can also discuss conventional hormone therapy. Call (303) 443-0321.

MENO_ READING

• Ourselves, Growing Older: Women Aging with Knowledge and Power. Letty Cottin Pogrebin
• Midlife and Older Women Book Project $15.95 in paperback 511 pages
  - Paula Brown Doress, Diana Laskin Siegal - By the same Boston Women's Health Book Collective as the first "Our Bodies, Ourselves" and "The New Our Bodies, Ourselves." Lots of wonderful photos, charts, and diagrams. Section 1 is "Aging Well" and includes six chapters: Aging and Well-being, Habits Worth Changing, Who Needs Cosmetic Surgery? Reassessing Our Looks and Our Lives, Weighty Issues, Eating Well, Moving for Health (about exercise). Section 2 is 'Living with Ourselves and Others As We age' with nine chapers: Sexuality in the Second Half of Life (includes both hetero and homosexual information), Birth Control for Women in Midlife, Childbearing in Midlife, Menopause: Entering our Third Age, Relationships in Middle and Later Life, Housing Alternatives and Living Arrangements, Work and Retirement, Money Matters: the Economics of Aging for Women . . ." Excerpted from the Menopaus List.

  

  NHRT:HORMONE REPLACEMENT THERAPY
  Power Surge does not endorse the use of conventional, synthetic hormones

  Some of the major symptoms and body changes that happen with menopause can be helped by taking hormones. Many doctors continue to recommend conventional synthetic HRT, such as Premarin and Prempro, even with the controversy surrounding synthetic hormones resulting in the abruptly halted WHI (Women's Health Iniative) Study in 2002. Read more about The HRT Controversy here.

  However, many women who want to use HRT are asking their doctors to prescribe naturally compounded, bio-identical, plant-derived hormones instead. Hormone replacement therapy helps to relieve many symptoms related to menopause that women may not be able to relieve through the more natural methods. Many of their symptoms are due to the drop in both estrogen and progesterone during the peri and postmenopausal years. The benefits are:

• Hot flashes and sweats: milder and not as frequent. For most women they will disappear completely.
• Less emotion: less anxious, less irritable, and less depressed.
• Vaginal and urinary tract problems: relieves vaginal itching and burning.
• Moistens the lining of the vagina. This may take a month. If you have burning
• when you urinate, call the advice nurse right away.
• Heart disease & stroke; may help to lower the chances of heart attack or
• stroke by improving blood cholesterol levels.

  Osteoporosis: slows down bone loss that results from aging. Over a long period of time this can mean fewer broken bones. Eating a balanced diet, exercising regularly, living a healthy lifestyle, and taking a calcium supplement may provide more protection against osteoporosis.

  Today's HRT Programs Reduce Risk :We now use low doses of "natural" estrogens alone or in combination with progerone (avoid synthetic progestins). Combining natural estrogen (estradiol, estriol, estrone) with natural micronized progesterone (as opposed to progestins, such as Provera - the progestin found in Prempro) helps protect the uterus. Estrogen and progesterone together is the best treatment for most postmenopausal women. Estrogen may be used alone if you have had a hysterectomy. Where higher doses were once thought to be necessary, research has shown that, in most cases, lower doses are just as effective and cause less side effects. Regular breast examinations by a health professional and self-examination are recommended for all women. A mammogram is recommended for women as they get older [Read more about breast examinations in Power Surge Newsletter #16.] When estrogen is given alone, there is a risk of pre-cancerous changes in the lining of the uterus. In some instances this may lead to cancer. If you are at risk, your doctor may do a biopsy. The progesterone causes the uterus to shed built-up tissue at the end of each cycle. Your doctor will help you choose the combination which is best for you. If you do not have a uterus, it's okay for you to take estrogen alone.

  Side Effects of HRT

  Estrogen - Although most women who take estrogen don't notice any side effects, they may occur in some women. Side effects can include any or all of the following problems.

• Fluid retention
• Irritability
• Breast tenderness
• Swelling of the body
• Abdominal cramping

  Let your doctor know if you have these side effects. Perhaps a change in dose will help you.

  Progesterone: Often there is a return of light menstrual periods. The bleeding is not heavy. It is more like spotting for 3 to 4 days.Usually, these monthly periods are not associated with PMS or cramps. For women who are already a few years into menopause, the dose can be adjusted to stop bleeding. It is possible that progesterone may raise fat and sugar levels in your blood. If this is a concern to you, you should discuss this with your doctor.

  Summary: NHRT does much more than just relieve the uncomfortable symptoms of menopause. Long after these symptoms stop, taking estrogen and progesterone can protect your bones, prevent osteoporosis and strengthen your vaginal tissues.

  

  ESTROGEN & WEIGHT GAIN

  Postmenopausal women who fear flab might consider getting their estrogen by patch rather than pill.

  Endocrinologist Anthony J. O' Sullivan and colleagues at The Garvin Institute of Medical Research asked 18 women past menopause to try one of two forms of treatment: daily, standard pills of 1.25 milligrams of estrogen or an equivalent, time-released dose conveyed through a skin patch worn round-the-clock. After six months, each woman switched modes.

  Patches and pills were equally effective in maintaining the women's bone density and reducing hot flashes and other menopausal symptoms. But by analyzing breath samples, the researchers were able to chart changes in the women's metabolism, and found that when on the pills, their bodies traded between one and four pounds of muscle for fat. The patch had no such effect.

  That's not a complete surprise, O'Sullivan says. While hormone released through the skin spreads throughout the body via the bloodstream, estrogen that is swallowed almost immediately hits the liver, which plays a major role in metabolism. A big dollop of estrogen seems to trigger signals, via the liver, that fat's to be stored instead of burned.

  The "patch advantage" won't help anybody squeeze into a smaller swimsuit, O'Sullivan hastens to add. Only the ratio of fat to muscle changed; overall weight stayed the same. But, if the findings from this preliminary study hold up, he says, the skin patch might be a better choice for women with some obesity-linked diseases.

  

  PREMARIN AND ANIMAL ABUSE

  In the past number of years, the animal rights group People for the Ethical Treatment of Animals has mounted a campaign against Premarin, the most widely prescribed estrogen replacement. PETA charges that horses are mistreated in the manufacture of the drug, made from the urine of pregnant mares. While the group has an ax to grind--it opposes all animal husbandry--more mainstream organizations, such as the World Society for the Protection of Animals, have also expressed their disapproval.

  In response, Premarin's manufacturer, Wyeth-Ayerst Laboratories, recently agreed to let a panel of international experts visit 32 farms. The company issues a detailed set of guidelines and, according to Tom Hughes, of the Canadian Farm Animal Trust, horses get sufficient food, shelter, and vet care.

  But panelists reported a number of concerns. The mares spend at least six of the 11 months of their pregnancy tied in stalls in which they can tread in place but cannot turn around. They are exercised outside their stalls no more than once a week; some are not let out from mid-September until late March. In many cases, says panelist Joe Silva, the stalls are too small for horses to lie on their side, their natural sleep position, or to groom themselves. And the horses are kept thirsty (though not dehydrated) to keep their urine concentrated. Wyeth-Ayerst says it has already stepped up its inspections of the farms and that it will consider the panel's concerns.

  Women looking for alternatives should know that many doctors are most comfortable with Premarin, the best-studied estrogen replacement. But according to the North American Menopause Society, other forms of prescription estrogen, such as those made from soybeans or yams, seem equally effective at reducing hot flashes and other menopausal symptoms as well as at cutting the long-term risk of osteoporosis.

  See the transcipt of the chat with Wyeth-Ayerst Pharmaceuticals - manufacturer of Premarin.

  

  MENO_SOY FACTS

  Soy Foods? Lower Cholesterol, Fight Breast Cancer, And Slow Bone Loss? For six months, a group of three dozen research volunteers at the University of Illinois, Champaign-Urbana, agreed to add soy protein to their diets, not just for breakfast but with every meal. They're as willing a group of guinea pigs as you'd hope to find--and with good reason, according to food scientist John Erdman, Jr., who's codirecting the research. Dozens of studies --including an overview featured this summer in the New England Journal of Medicine--have shown that soy protein can dramatically lower cholesterol. And now there's evidence that an estrogenlike substance (or phytoestrogen) found in soybeans can relieve some side effects of menopause and even slow down osteoporosis. What's more, it might cut the risk of many forms of cancer.

  "Wouldn't that be wonderful?" says a trim woman in her mid-fifties who lives on a farm north of town. Like others, she has fretfully watched her cholesterol level climb since menopause, and she's concerned about osteoporosis. Still, she's reluctant to go on estrogen therapy. "My mother died of breast cancer," she says, "and it worries me that estrogen might raise my risk."

  Could soy be an alternative? Certainly in countries where it's served at virtually every meal, rates of heart disease and many forms of cancer are unusually low.

  In Shanghai, the average cholesterol level hovers around 165; here, it tops 200. In Japan, where tofu has an honored place at the table, breast cancer is four times less common than in the United States.

  Of course, Asian diets differ from Westerners' in many ways, so it's hard to pin such benefits on soy alone. But it's getting easier: In one study at the University of Milan, patients who stuck to a moderately low-fat diet had only modest decreases in cholesterol, but when researchers added soy protein to their diets--without making any other changes--their "bad" LDL cholesterol fell an average of 21 percent in three weeks.

  So far, most of this heart-friendly evidence comes from studies of men; the Illinois researchers are the first to focus on women--but they're looking beyond cholesterol. By comparing before-and-after bone scans, they'll also investigate whether soy foods can really retard osteoporosis as scientists suspect. Based on animal studies, the premise hinges on those estrogen look-alikes in soy. Called isoflavones, these bear so strong a resemblance to the hormone in a woman's body that they may be able to fill in when her own levels start to fall.

  That's more than conjecture. At the Dunn Clinical Nutrition Centre, in Cambridge, England, researchers have shown that daily servings of soy protein lengthen menstrual cycles in premenopausal women, suggesting an estrogen-like effect. Also, several as-yet-unpublished studies suggest that isoflavones can alleviate hot flashes and night sweats in menopausal women, according to Mark Messina, a former program director in the Diet and Cancer branch of the National Cancer Institute who recently organized the first international symposium on soy foods and health. While more studies are needed, he's optimistic: "I'd bet good money soy protein will become a widely accepted alternative to estrogen replacement therapy within the next few years."

  But what about estrogen's potential not-so-positive effects? Specifically, if isoflavones behave so much like the human hormone, couldn't they raise a woman's risk of breast and ovarian cancer as well? Actually, they might do just the opposite--reducing the risk instead. As Messina explains, isoflavones are a lot weaker than human estrogen, "about one-thousandth the potency of the bodily hormone--or less. They're close enough in structure to fit into the estrogen receptors on breast cancer cells," he adds, "but probably too weak to stimulate the cells."

  The result, he says, is like putting the wrong key in your front door. "The key will slip in, but it won't turn the lock. And by jamming the lock, it prevents other keys that come along from opening it."

  Soy isn't the only source of plant estrogens; scientists have identified three different kinds that are found in hundreds of other foods, from carrots and potatoes to bean sprouts and sunflower seeds. Yet soy is a particularly rich source, and there's growing evidence that a particular form of isoflavone it contains could actually defend against cancer of many kinds. Called genistein, it's a potent antioxidant, able to snare unstable oxygen molecules before they turn healthy cells cancerous.

  Genistein also appears to block several key enzymes that tumor cells need to grow and thrive, and studies show it may also thwart the growth of blood vessels supplying those cells--effectively starving them at the source. The findings are so impressive that the National Cancer Institute is now studying the potential of purified genistein as an anticancer drug.

  "But why wait?" Messina says. Genistein is so abundant in soy foods that one serving a day, he suspects -- a glass of soy milk, a half-cup of firm tofu, or muffins -- is probably enough for most of us to substantially lessen our cancer risk; at least twice that much, or about 25 grams of soy protein, could significantly lower cholesterol. (How much it would take to stand in for estrogen therapy is unknown.) The Breakfast Clubbers have agreed to consume 40 grams of soy protein a day, which they manage by supplementing soy-laced meals with soy beverages and snacks.

  It's well worth the trouble, if you ask study veteran Karen Hyde. When she started on soy, her total cholesterol stood at a hazardous 255; six months later it was 205. And as her LDL cholesterol went down, her HDL--the "good" kind--went up. "My doctor could hardly believe it," she says.

  Pulling up a chair, John Erdman concurs: "Those are remarkable numbers." Because the experiment isn't over, he's reluctant to say more. Well, maybe a little more. "Let's just say the numbers are all going in the direction we'd like to see."

  Reference: Excerpted from "Health" Magazine

  

  SOY_SOURCE

  Soy food comes in several forms, many of them rich in the potentially disease-fighting estrogens called isoflavones (though products like soy sauce contain almost none). And while not all are exactly low in fat--some tofu has almost as much as cheese--some reduced-fat versions are available. Here are tasty ideas for adding a little soy to your life:

• Fresh soybeans: Harvested while green and boiled for 15 minutes in salted water, these make a great appetizer or snack; called edamame in Japanese, they're sold in Asian groceries in the summer months.
• Dry soybeans: These fit easily into any baked-bean dish or chili. The only drawback: They take two to three hours to cook.
• Soy milk: Pour it on cereal, stir it into hot drinks--in fact, use it pretty much interchangeably with milk. Soy milk is available at supermarkets in regular, low-fat, nonfat, and flavored versions, in unrefrigerated cartons that should be refrigerated after opening.
• Tofu (bean curd): Soft, medium, firm, and low-fat varieties make this a versatile addition to pastas, noodle casseroles, stir-fries, and soups; it's also a good creamy base for blended sauces and salad dressings.
• Soy protein powder: Quick to dissolve and almost devoid of flavor, this powder slips unnoticed into recipes or drinks (but go easy in baking, as it gives breads a denser texture). It's available from Physicians Laboratories as as Revival Soy Protein , (800) 700-8687, or E-mail Dr. Tabor , Medical Director for more information.