(Ruth Jacobowitz's seventh visit to Power Surge) Dearest: My guest tonight is Ruth Jacobowitz, women's health advocate, lecturer, author of "The 150 Most-Asked Questions About..." series of books including, "...Menopause", "...Osteoporosis", "...Midlife Sex, Love and Intimacy", and "The Estrogen Answer Book." Ruth is affiliated with numerous national health organizations and has appeared as an expert on numerous national radio and TV shows. Ruth's articles have appeared in many publications. She has a syndicated column, "Health Matters" and writes for "Your Health" magazine and "The Chagrin Valley Times." Ruth was also a former vice-president of Cleveland's Mt. Sinai Medical Center. Ruth, welcome back to Power Surge. If hormone therapy is so important as women age, why do you think it is that when I started Power Surge in 1993, 20% of women of menopausal age were using HRT and today, in 2001, still only 20% of the same age group are using HRT? Ruth Jacobowitz: Women still are afraid and their number one fear seems to be breast cancer. Dearest: And the adverse side effects they experience when they try it? Because the percentage of women who start and stop it within a year is very large. Ruth Jacobowitz: I think women don't give it a chance and also they are not willing to do the trial and error to find the right estrogen. Dearest: Thanks, Ruth. Athena, go ahead. Ruth Jacobowitz: You're welcome. Athena: I started using HRT 3 months ago, I don't intend to use it for long approximately 3 years. Do you think by using it for 3 years it will be beneficial? Ruth Jacobowitz: Three years may help stop the short term symptoms that are bothersome, but will not help with the long term benefits, such as preserving the health of your bones. Athena: I have osteopenia, and I was told that it won't take effect before 18 months. I wondered if that was true, and does that mean I'm not "protected" until then. Sorry I wasn't clear. Ruth Jacobowitz: I really have not heard that before. I think that is something to discuss with your own physician. Sorry. Athena: OK thank you Dearest: There are still so many unanswered questions about hormone therapy, especially in the area of heart disease prevention. There are those who claim HRT has never claimed to be able to protect women from heart attacks. The preliminary results of the Women's Health Initiative don't look strong regarding HRT and heart protection. Why the conflicting opinions about this very important issue? Ruth Jacobowitz: Your point is so well taken! One study confounds another. I'm inclined to follow the HERS study, which seems to indicate that women with heart disease should not start HRT and women who have been on it for more than a year should not stop. Dearest: Yes, I've read that as well -- that if women are inclined down the road to have a heart attack or develop heart disease, which many of us don't know when we start taking hormones, those hormones could precipitate a heart attack, yes? Ruth Jacobowitz: I'm just not sure about precipitating a heart attack. It's a cloudy issue. And, of course, you're right we don't know when we start whether or not a heart attack is in our future. Dearest: Hence the confusion about HRT. Thanks, Ruth :) Jeanne, go ahead. Jeanne: I have gone through the whole menopause thing (postmeno now) without any HRT and now a nurse practioner wants me to try it. Why should I even consider it? and I have had a heart attack already. Ruth Jacobowitz: Dearest, you know so much about this. I just love chatting with you and the others. Dearest: Thanks, Ruth :) Likewise, of course. By the way, Jeanne, we might add that heart disease runs rampant in your family, I believe. Jeanne: yes Ruth Jacobowitz: Jeanne, that's a good question. If you've had a heart attack I would surely have your doctor explain to you the reasons for starting HRT. Heart disease in your family raises other issues, of course. Jeanne: I haven't talked to my cardiologist about it would he even know? Ruth Jacobowitz: Yes, if I were you I would definitely discuss it with your cardiologist. Dearest: That's what I meant above, Ruth. In reading over the preliminary results of the WHI, it seemed so clear that women with a predisposition to heart disease HAD more heart episodes on HRT than those with no predisposition to heart disease. I should say, within the first year or two of using it. Ruth Jacobowitz: Dearest, you are 100% correct. Jeanne: Thank you Ruth, I almost have a heart attack thinking about trying it though, so I probably will pass. Dearest: Jeanne, you are not a candidate for HRT. Ruth Jacobowitz: I agree. Dearest: And any doctor who prescribed it to you should have his license taken away. PepsiLady: I been having problems bleeding I'm been taking pro-vera tabs. still bleeding. Ruth Jacobowitz: Are you taking Provera alone? No estrogen? PepsiLady: Alone Ruth Jacobowitz: When you are having break through bleeding, you need to talk to your doctor about changing the dose or the type of progestin. Perhaps Prometrium would be a choice. PepsiLady: They updosed it to 10 mg. Ruth Jacobowitz: Yes, but different preparations work in different ways. How long have you been on the higher dose? PepsiLady: 1 month Ruth Jacobowitz: That's probably long enough to expect relief. PepsiLady: Clotting alot. no relief Ruth Jacobowitz: Again, maybe a different product would work better for you. PepsiLady: Thanks Irene: I have a history of hyperthyroidism. Could HRT aggravate or exacerbate that issue? Ruth Jacobowitz: Usually not. Irene: Thank you. Sydney: I had a hysterectomy in June. I use biest and testosterone..what is the purpose of progesterone after a hysterectomy? The doctor seems to think I should be using progesterone too. Ruth Jacobowitz: Progesterone assists in sloughing off the lining of the uterus. No uterus, no need for progesterone or progestin. Biest is two kinds of estrogen. Sydney: I needed it for a lot of head stuff before the hysterectomy. Okay..I know and getting the testosterone correct was fun too. Ruth Jacobowitz: I'm sure! Dearest: Ruth, but isn't that the old school of thought - not using progesterone after an hysterectomy? Don't they think today that women should have a balance of hormones after hysterectomy, especially if they are young women? Ruth Jacobowitz: Sydney, I guess we need to know how old you are. Sydney: I feel very good now. 44 Ruth Jacobowitz: At 44, I do believe that the biest and the testosterone may be sufficient. Sydney: Anyway, I'm not ready to try progesterone just yet..I feel too good to mess it up. Ruth Jacobowitz: Glad you feel good. Sydney: Thanks Dearest: Ruth, while we're on this subject, I've read that one-third of women in this country have had hysterectomies. A poll on my site shows 70% of women think many doctors recommend hysterectomy too quickly. I thought about 15 years ago, after the controversy about this surgery, those numbers would drop. How do you account for the rise in hysterectomies? Ruth Jacobowitz: Good question, Dearest! The numbers have dropped ever so slightly, but not enough to make a difference. When I wrote my book, we were still doing about 600,000 hysterectomies in the U.S. alone and, you're right, about 2/3s are unnecessary. Dearest: The book Ruth refers to is one of her 5 or 6 six books, her last -- The Estrogen Answer Book: The 150 Most-Asked Questions About Hormone Replacement Therapy. It makes me wonder, Ruth. Do you think doctors just jump in and do hysterectomies because they anticipate women will have problems anyway? Ruth Jacobowitz: That sounds so old school and maybe that is the reason. I personally think we should keep everything intact if we can and only submit to surgery if there's a good reason. Dearest: I think we have more than a general problem of terrorism in this country. I think we almost have a form of medical terrorism (no law suits, please) Ladybird: Once HRT is started will you have to take it for the rest of your life? and how do we know when menopause is over if we were surgically induced? Ruth Jacobowitz: The president just concluded, so we can get back to our health. Dearest: That was thoughtful of him. Ruth Jacobowitz: Dear Ladybird, many women do continue on HRT throughout their lives. Others use it for fewer than 15 years, the number of years that we told it may be safe. I feel comfortable on ERT, feeling that I am merely replacing what I used to have, others disagree. It really is each woman's choice. Dearest: fibroid and polyps is hysterectomy usually recommended? Ruth Jacobowitz: Hysterectomy may be an option, but often there are simpler ways to remove those extra tissues. PepsiLady: Again, thank you Jackiern: I entered surgical menopause at 30. Now 35, still dealing with many issues especially sexuality issues. No desire AT ALL! I've even tried testosterone! I think it's physical but my hubby thinks I'm just not "in to it" He doesn't understand things change. Ruth Jacobowitz: Not all testosterone is the same either. Sometimes injections or pellets work better for some women, while capsules or lozenges work well for others. What have you tried? Jackiern: I have tried estratest Ruth Jacobowitz: Interesting. Estratest doesn't work for many women, however, often the other forms of testosterone mentioned about do. The reason libido sometimes flies out the window at menopause is because most of us lose the bit of testosterone we had when we lose our estrogen and progesterone which is what menopause is all about. Thinkin: I had a hysterectomy at 40 (the terrorist type), after being put on HRT, I gained 30 lbs in 2 months. I couldn't get it off, so I stopped the HRT (several HRT's didn't help symptoms anyway), now I still can't get weight off. Why??? Ruth Jacobowitz: I always like to say that estrogen doesn't cause great weight gain, the slowing of our metabolism that begins around 35 does. Thinkin: Any suggestions to jump start metabolism???? Ruth Jacobowitz: I always write and say that after 40 we've all got to eat less and move more. Exercise daily is the best way to jump start metabolism. Giving up carbohydrates helps, too. Thinkin: And, if estrogen doesn't put the weight on, I wonder why it came on within 2 months of starting HRT. Ruth Jacobowitz: Thirty pounds in two months is quite a bit. Have you talked with a nutritionist? by Power Surge. All Rights Reserved.