Dearest: My guest tonight is Dr. Duane Townsend, a Board Certified Obstetrician/Gynecologist. He has developed various techniques and programs within the fields of gynecology and oncology. He popularized "colposcopy" and introduced "rollerball" ablation. This is performed as an option to hysterectomy. He was the first to train and use "nurse practitioners" in gynecology. In addition, he is a fellow of the American College of Obstetricians and Gynecologists.
He has nearly 100 articles in peer review journals, has written over 20 chapters for various text books and co-authored the first text book on Gynecologic Oncology now in its 5th edition.
Dr. Townsend taught at the University of California at Los Angeles, the University of Southern California, and the University of Utah. He now practices and resides in Utah. Dr. Townsend's first book for women is "A Maverick of Medicine Speaks To Women: A World Renowned Gynecologist's Solutions for a Better World in Women's Health."
Welcome back to Power Surge, Dr. Townsend.
Duane Townsend, M.D.: Thank you. I'm pleased to be here.
Dearest: Dr. T., pardon my French, but what the HELL has happened to our healthcare system when a woman goes to her gynecologist with normal and viable menopausal symptoms, and her complaints are dismissed as "emotional issues" to be treated by anti-seizure, anti-anxiety and/or or anti-depressant medications?
Duane Townsend, M.D.: Physicians have gotten away from talking to patients and listening to patients. It's due primarily to the HMO, PPO money first, patient second mentality.
There's too much negative hype on cancer risks with estrogen which is over-exaggerated and totally misunderstood by the vociferous and controlling academia.
Dearest: What, can we as lay people, who want and need better health care, DO about it?
Duane Townsend, M.D.: Become better educated, listen to those individuals who are willing to buck the trend, step out of the box and take charge of your own healthcare. For a starter, read my book. It will change your life.
NurseLisa: My gynecologist says my FSH is normal so I am not in perimenopause at this point. But I have severe anxiety I never had before, lightheadedness/dizziness and off-balance feelings along with heavy irregular periods, night sweats etc. She says it's not perimenopause yet. Others on here say dizziness is common in perimenopause. Most books don't mention it at all. Why? It's my worse symptom and all other diseases have been ruled out. I'm 46. I probably need to read your book instead, right?
Duane Townsend, M.D.: Correct. You need to read my book! You no doubt have estrogen dominance. It's listed as one of our common complaints in women who have estrogen dominance which is so common in perimenopause. The dynamic duo make a huge difference in your life. This is fully explained in my book. The dynamic duo is genestein and natural progesterone. Also isoflavones.
Dearest: Genistein = isoflavones :)
NurseLisa: Thanks Dr. T, you have no idea how much I needed to hear this.
Angel0508: Is it true that menopause is the worst at the beginning and the end? How long does it last? My hot flashes left now they are back.
Duane Townsend, M.D.: Once a woman is into menopause, you're into menopause forever. The many disquieting symptoms of menopause - hot flashes, anxiety, etc. - can easily be managed with low dose estrogen (bioidentical) isoflavones and natural progesterone cream. This combination can be and should be taken for the remaining years of a woman's life and should not be stopped.
It makes no sense to stop taking the beneficial effects of estrogen when the negative aspects of estrogens can be easily modified.
Dearest: What kind of estrogens are you speaking of? Over the counter phytoestrogen creams? Prescription natural, bio-identical estrogens? And what kind of progesterone - OTC creams or prescribed natural micronized progesterone?
Duane Townsend, M.D.: For estrogens there are two major sources: bioidentical and those by prescriptions from the drug companies. The major difference between the two is that there are fewer preservatives in the bioidentical and therefore, may be better for the person. However, the estrogen component is essentially the same; it's what's the hormone is placed into that makes the bioidenticals better.
The natural progesterone is primarily delivered in a cream form and virtually all of the natural progesterone creams are USP grade in their quality and are micronized. They can be obtained by prescription from a compounding pharmacy or there are many natural progesterone creams that can be purchased over the counter. However, I would be cautious with the over the counter creams as there may be some questions of quality. You must know your source in order to be able to have a dependable product.
Power Surge has excellent sources of bioidentical hormones, both estrogen and progesterone.
HephzibahBeulah: I had a total hysterectomy in 1995 (I still have my ovaries). I am 54. My latest physical challenge is this strange intermittent vaginal sensation that is very uncomfortable and disturbing. Any ideas what this could be and any suggestions on how to fix it, make it go away. Thanks Dr. Townsend. I know you did not just say this is forever. Just kill me now.
Dearest: What does the sensation feel like?
HephzibahBeulah: It feels like something internally moving on and off.
Dearest: Like internal shaking?
HephzibahBeulah: I have that too, but this is vaginal.
Duane Townsend, M.D.: I suggest you see a physician, have a thorough examination including a vaginal probe ultrasound of the pelvis. It's impossible to make a diagnosis without an actual examination.
1Diana: What are your thoughts about endocrinology (balancing of all hormones) being the cutting edge of anti aging, wellness and longevity? I welcome your view on blood tests VS saliva please! Thank you for your respect of self empowered, self educated people! It's hard to find a doctor like that!
Duane Townsend, M.D.: I am not a fan of using hormone testing, either saliva or by blood. I have seen a number of patients who, based upon hormone testing, were mismanaged. I try to listen to the patient's symptoms, I try and come up with a program that I think will resolve their problems. We start with a basic dose and then we'll adjust it up or down depending in symptoms, not blood or saliva tests.
Tests that I would depend on would be related to the cardiovascular system, renal, liver, etc. Hormone testing is quite variable since hormone levels can go up and down in an unpredictable fashion in an individual. This is particularly difficult during the perimenopause.
Angel0508: I have taken Black Cohosh and it helped. I stopped because flashes were gone. Should I start taking it again? Does it help with anxiety? Should I take Kava?
Duane Townsend, M.D.: Taking black cohosh to avoid estrogen doesn't make sense unless there is a specific reason why you shouldn't take estrogen.
The benefits of estrogen are overwhelming, particularly when there's really good data to support the ability to make them safe, easily and simply. This is fully explained in my book.
Sdeek: I've taken an HRT for several years, one pill twice a week. It has worked very well and I have had no real menopause symptoms. I decided I wanted to go off hormones so I asked my doctor to put me on lower dose. She did and all of a sudden I had extreme dizziness off and on (for 2 months now), shakes, palpitations (I have an anxiety disorder anyway), cold hands and feet, waking in the night feeling like I can't breathe and on and on and on.
Can all this happen when going off HRT? I increased the lower dose by every other day and have started using progesterone cream on the days I don't take a pill. My hopes are to eventually go off completely, but now I'm scared to. I can't stand the vertigo.
Duane Townsend, M.D.: It sounds as if you need to go back on estrogen at a sufficient dose to control your symptoms.
Sdeek: PremPro is what I am on. Do I go on something natural instead?
Duane Townsend, M.D.: What I have found to work extremely well in legions of women is low-dose estrogen, bioidentical are probably best, along with isoflavones and natural progesterone cream. One will adjust the dose of estrogen to control the symptoms. The isoflavones and the natural progesterone will essentially block the bad effects of estrogen thereby maximizing the beneficial effects of estrogen. Power Surge has a superb source of bioidentical hormones and isoflavones.
Chippewa: What do you consider a "basic dose", let's say, for progesterone, if someone is having menopausal symptoms? And, don't most women make enough estrogen in their lifetime, that all they need is a little progesterone to counter-balance the estrogen?
Duane Townsend, M.D.: If a woman is still menstruating, she indeed may have enough estrogen and an inadequate amount of progesterone. This is referred to as estrogen dominance or estrogen excess. In these cases, natural progesterone cream of at least one percent applied properly will be effective in many cases. However, the effectiveness of the progesterone will be significantly enhanced by adding isoflavones to the regimen.
JulieMo: I am 45, had a total hysterectomy 1 year ago (I kept my cervix). I've been on the patch, hated it. I tried Femring and love it. I started out on lowest dose. My doctor moved me up to .10. The problem is I still smoke some. My doctor says I have to totally stop. This is hard. How bad is it to smoke and take estrogen?
Duane Townsend, M.D.: There is an association between estrogens and increased risk of heart attacks in smokers. However, smoking also severely depresses one's immune system making you more susceptible to other illnesses. Therefore, try and quit smoking.
NurseLisa: What causes us to have an off balance feeling sometimes, or a feeling of wooziness while in perimenopause? What do the hormones do to cause this to happen? Sometimes I feel like I'm leaning so far to the right I might tip over! I have been checked for inner ear stuff and that's all ok.
Duane Townsend, M.D.: There are many symptoms of the perimenopause, dizziness being one. You should be able to control your symptoms by getting the hormones back in balance with isoflavones and natural progesterone cream. Power Surge has an excellent source for these products.
Dearest: They can be found on the recommendations page at: www.power-surge.com/recommend.htm.
Angel0508: I want to take herbs instead of medications. Is Kava good for anxiety?
Duane Townsend, M.D.: We no longer recommend Kava because of potential side effects. We recommend St. John's Wort for anxiety. Are you menopausal? Are you taking hormones? Are you perimenopausal or post-menopausal?
Angel0508: Yes, I am in menopause. No, I don't take hormones. I tried St. John's Wort and it made my anxiety worst. Also, it made me feel depressed.
Duane Townsend, M.D.: To help your problem I would suggest you try low-dose bioidentical estrogens, isoflavones, and natural progesterone cream.
Dearest: Isoflavones = Revival or Genistein.
1Diana: I'm 52 and menopausal for 7 years. I no longer have the 'flashes' etc. What I'm grievous about is the lack of physical desire for sex. I take BiEst .5 mg Estradiol 2 mg estriol, twice a day. 100 mg progesterone. I will be starting on testosterone .625 sublingual. I have recently switched to BPharmacy (Bellevue Pharmacy Solutions). Sexuality is good once it gets started. I'm just not DESIROUS as I used to be, sure do miss that, yet am always psychically willing! Although I'm still orgasmic, it's harder to achieve. I take DHEA 12.5 also. Am I wishing up a tree that doesn't exist?
Duane Townsend, M.D.: It sounds as if you are taking the right steps in order to re-establish some of your earlier psychological desires. Realize that as we get older some of our younger thoughts and activities do change. Be thankful for what you are able to enjoy because many women don't even have what you are now experiencing. The testosterone should help a great deal.
Dearest: If you still have the same problems after using the testosterone, feel free to write Dr. Townsend at www.power-surge.com/asktheexperts.htm.
Marlo: I'm in menopause almost six years now. I learned to cope with my hot flashes. Now I have been feeling very off balanced lately, almost like Parkinson's. I check out fine. Blood normal. What could I do, or take? I drink Revival.
Duane Townsend, M.D.: I would suggest that you take a low dose bioidentical estrogen, along with the Revival and natural progesterone cream.
HephzibahBeulah: When you have had a hysterectomy, how do you know if you are perimenopause, menopausal, or post menopausal? I am 54. I started having hot flashes in my late 30's, multitude of symptoms along the way. I am a student so I have no insurance for doctors. I have been managing symptoms with healthy diet, exercise, soy and prayer.
Dearest: Menopausal and postmenopausal mean the same thing :)
HephzibahBeulah: And it is forever, huh?
Duane Townsend, M.D.: The odds are you are post-menopausal. The best way to manage this is low-dose bioidentical estrogen, isoflavones, and natural progesterone cream. It is difficult to eat an adequate amount of soy to achieve the necessary levels of isoflavones.
Sdeek: Can you take bio-identical estrogen and PremPro at the same time? Or can you abruptly end the PremPro and start the other? How do you know what dose to take?
Duane Townsend, M.D.: You can stop abruptly if you resume the bioidentical estrogen the next day. A one milligram dose of estradial would be a good level to start. You must also take isoflavones and use natural progesterone cream to balance your system.
Sdeek: I'm not sure what isoflavones are.
Duane Townsend, M.D.: Isoflavones are plant estrogens that come from soy, red clover, and kudzu. The most common source is from soy.
Dearest: How long is it safe for a women to take estrogen?
Duane Townsend, M.D.: I think a woman can take estrogen for the rest of her life as long as she includes isoflavones and natural progesterone cream. Estrogens as you know are anti-aging, help reduce heart disease, prevent osteoporosis and help to keep the pelvic organs healthy.
NurseLisa: Do you need to have a biopsy of uterus or any other medical clearance before starting on progesterone cream etc. to rule out any problems before starting?
Duane Townsend, M.D.: It is not necessary to have a biopsy of the lining of the uterus before starting hormone therapy including progesterone cream. A biopsy is performed when there is some concern of abnormal cell growth within the uterus.
Sdeek: I heard on the radio today that they are now saying too much Vitamin E is not good for your heart. It's good for cancer but not the heart. What is too much? I read on Power-Surge that we should be taking at least 600 IUs.
Duane Townsend, M.D.: Unfortunately, what's bad today may be good tomorrow. Use a sensible does of Vitamin E as suggested on PS, i.e. up to 600 IUs a day, but no more than 200 at any one time.
Sdeek: Oh, the one I take is a 400 IU capsule. not good?
Dearest: Not good. Don't take more than 200 IUs at a time. Doctors don't tell you because they don't know that vitamin E has the potential especially in those predisposed to it. to spike your blood pressure when taken in high doses.
So when you see it on sale, 1000 IU's in GNC or somewhere - stick with the 200 IU's.
Sdeek: Wow - I'm shocked.
Dearest: A bargain isn't a bargain if it kills you.
1Diana: You being a man, what are you personally doing for yourself as far as andropause goes? The male "menopause"? Just curious. The focus on hormones and life change is heavily focused on females. What is this bias and do you see one too? Getting older is not a disease state and men are as deeply affected as women with the aging issue! What are your thoughts on nitric oxide formulating foods and its affect on sexual desire?
Duane Townsend, M.D.: I'm 71 years young. I take a variety of supplements, NO prescription drugs, all systems are fully operational and I feel I'm getting younger.
1Diana: Well, do tell! NO hormones? Then why IS the focus so much on females? What makes us so different?
Duane Townsend, M.D.: The secret: I take high dose Transfer Factor, a product to reduce my chance of prostate cancer, a proprietary product called MalePro which will reduce my risk of prostate cancer dramatically, and Omega 3 fatty acids, and a multi vitamin, and a product called Recall which sharpens my mind and has improved my memory tremendously.
Dearest: Can you explain what Transfer Factor is to those who aren't familiar with it?
Duane Townsend, M.D.: Transfer Factor is fully explained in my book. Transfer Factors are peptides that are memory messengers for the immune system. We make them whenever we become ill, i.e. colds, sore throats, infections, and they then prevent us from becoming re-infected with the same virus or bacteria at a later date. They are transferrable from mammal to mammal. All mammals make them. They are essentially the same peptides from mammal to mammal. They have no side effects and can be used in a day-old child or a hundred-year-old person.
Dearest: If you want anymore information, you can E.mail Dr. Townsend at DrTownsend@power-surge.com.
Angel0508: What vitamins are the best to take during menopause? B-12, B-6, Vitamin E, Vitamin C - are these all good? Or do you think I am wasting my money buying them?
Duane Townsend, M.D.: They are all good.
Dearest: Try taking Active Women's Multi - it's on the recommendations page of the site. It has all these vitamins and anti-oxidants plus other vita nutrients essential for women at midlife. You'll find it at www.power-surge.com/recommend.htm.
HephzibahBeulah: I take the 400 IU of Vitamin E too, what does it do that is bad?
Dearest: It can cause your blood pressure to spike, especially in those predisposted to hypertension as is frequently the case with women going through menopause. As we age, many of us become more vulnerable to hypertension and other age-related health issues. My recommendation would be to toss it out and buy the 200 IU capsules. You can read more about vitamin E and these cautions on the Recommendations page.
Dr. Townsend, thank you for joining us to answer our questions about women's health and menopause. I strongly recommend everyone read Dr. Duane Townsend's, "A Maverick of Medicine Speaks To Women."
Duane Townsend, M.D.: It was a pleasure to once again to be on Power Surge. I look forward to the next opportunity.
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