Please note that some of these are older archived transcripts. Bear 
in mind that many studies have been done and much new information has 
been discovered about the treatment of menopause issues in the past 
five years. Some doctors who may have routinely prescribed Premarin 
and Provera five years ago have many more options today. 



Dearest:     Tonight's guest in Power Surge is Dr. Allan
Aven, Power Surge's first medical consultant. He's savvy 
about menopause and vitamins. "Dr. Allan" is a veteran 
family physician in practice for 23 years in a northern suburb 
of Chicago, board certified, with special interests in clinical 
research, nutrition, and environmental medicine. 


 Dr. Alan Aven:    Thanks for the introduction.  It makes me
sound like I should be interesting.


SMartin992:  Doctor,  what do you suggest to heighten the sex
drive. I've lost all desire due to menopause. I am taking
Estratest.  Wondering what will improve my sex drive.  Seems
I lost it when I started menopause.



 Dr. Alan Aven:       First, did you have a drive prior to
menopause?  I believe you said you were on Estratest, but
for how long?

SMartin992:  I have been on it only a month and one-half. 
No changes though.

 Dr. Alan Aven:           I have found that the sex drive returns
within 5-7 days once the optimum balance is reached. 
Estratest only has 2.5 mg of testosterone. Male hormone
replacement requires about 50 mg a day.  The average woman 
will require about 2.5-10 mg if it is even going to work. 
There must also be a good balance with the estrogen. 
Progesterone tends to suppress the sex drive.  I also add
either full B-complex or large doses of vitamin B-6.

Klove543:    I've been on hormones for three years taking Ogen,
Provera, and 1/2 Estrace.  I am still sweating.  Help!

Dearest:     Is that your only symptom, Klove?

Klove543:         Yes.

 Dr. Alan Aven:           Klove, does the sweating bother you?

Klove543:         Of course, it is very uncomfortable.

 Dr. Alan Aven:      Is the sweating the only reason you are on
hormone replacement therapy (HRT) or are there multiple
symptoms such as insomnia dryness, headache, depression,
flushes, etc.?

Klove543:         All of the above.  I was sweating so I lost
track.

 Dr. Alan Aven:           I try to keep the HRT as simple as possible.
If sweating truly menopausal (and not, let's say due to
thyroid), then it seems that you are noton enough estrogen.
In Europe they start at 4 mg of estrogen. In the United 
States we start at 1 mg or less, but I have many patients
who require 1.5, 2 or even 3 mg.

Dearest:     Allan, many Power Surge women complain about
tingling in their extremities.  Can you explain why that
occurs during menopause?

 Dr. Alan Aven:           Tingling is due to nerve irritation that is
usually due to lack of B-complex.  That's why almost all of
my patient treated for menopause will be on B vitamins.

Dearest:     I take lots of Vitamin B, Allan, and have for
years.

YelRose:          Three years ago I took Estratest for a while
and I felt great.  Then I tried it again and I had chest
congestion.  Can you explain why?

 Dr. Alan Aven:           Yelrose, are you sure it wasn't co-incident
with an a bronchial infection or an allergy to something
else?  What symptoms are you calling "chest congestion"?

YelRose:          I don't believe so, as another approach was
to increase Ogen. I had the same reaction.  The chest
congestion was a feeling of tightness or what the
commercials call, an unproductive cough.

 Dr. Alan Aven:           True chest congestion with cough and
tightness could be an allergic reaction to something in the
pill, but it could also be a form of indigestion.

SingingDSR:  I am on the Estraderm patch and I am being
switched to Climara.  Should I notice any difference?  I
also take Provera.

 Dr. Alan Aven:           The mechanism of absorption is different
between the two, but the end result is the same.  You
shouldn't note any difference.

RCHCTH: Is it a good idea to do HRT with history of breast
cysts (drained several times)?

 Dr. Alan Aven:           Benign breast conditions will not be affected
adversely by HRT as long as the dose is within your
tolerable range.  Too much estrogen may cause breast
tenderness.

SMartin992:  I also have a major case of the blahs and
depression. Does the Vitamin B help that or does something
else? Also, what is dosage of Vitamin B or B-6 should I
take?

 Dr. Alan Aven:           Depression is easily treated with B complex
as long as it's simple depression.

SMartin992:  What dosage of B do you suggest?

 Dr. Alan Aven:           The dosage is different for everyone.  Try
100 mg a day at first.  You can safely increase to 300 mg a
day over a period of a week or so. Over 1000 mg of B-complex
can become toxic.

CATTN:  Is dizziness, constant light-headedness,and almost
faintness common in peri-menopause?

 Dr. Alan Aven:           Yes, Cattn, but a thorough exam and testing
are very necessary with those symptoms.

Jbuck1:      I have a questionable history of
endometriosis, migrane, and phlebitis.  Should I consider
HRT?

 Dr. Alan Aven:           Frequently, a non-cyclic hormone regimen will
prevent the ups and downs you normally experience with
normal ovarian function.  Therefore,HRT is not a problem
with regard to the endometriosis or migraines.  The 
phlebitis is another story.  Was it deep vein or uperficial?

Jbuck1:      Deep vein.

 Dr. Alan Aven:           Birth control pills are contraindicated with
a history of deep vein phlebitis, but the estrogen dose is
at least 10 times weaker with HRT and may not pose as great
a threat.  Once again, the quality of life issue is most 
important.  Are the benefits greater than the potential
risks!  That is a question you and your doctor must work
out.

Dearest:     Would it make a difference if it were deep
vein or superficial phlebitis, Allan?

 Dr. Alan Aven:           Superficial phlebitis is not a very serious
problem, it's the deep vein phlebitis that can kill.

Jbuck1:      I did have a bout with phlebitis while on
birth control pills before I knew I was infertile.

Batchika2:   I have one long hot flash all day, not just
at times I am too warm most all the time.

Dearest:     A potential risk when there's no history of a
problem is much different from when someone is predisposed
to something, isn't that correct, Allan?

NitaFar:          I had to stop HRT because it exacerbated
asthma with fluid build up and difficulty with breathing. 
Between taking Premarin and Estrace helped me make the
connection.  The asthma is manageable again.  Thanks.

 Dr. Alan Aven:           Sounds as if you were on too much estrogen
and you might want to try the patch.

Batchika2:   I have one long hot flash all day, not just
at times.   I am too warm most all the time.  Have you ever
heard of that?

 Dr. Alan Aven:           Are you on HRT already?

Batchika2:   No, I had trouble with swollen, sore breasts
using Estrace and the patch mainly.

 Dr. Alan Aven:           Flushing could be a sign of high blood
pressure or thyroid problems.  Have these been checked?

Batchika2:   Yes, I had thyroid antibodies, but they
disappeared.

 Dr. Alan Aven:           Was the flush controlled on estrogen when you
took it?

Batchika2:   Yes.

 Dr. Alan Aven:           Sounds like you were on too much estrogen. 
Perhaps try a lower dose.

Batchika2:   I tried half of .05, and it was still too
much!

 Dr. Alan Aven:           Try an even lower dose.  See if your doctor
will give you aqueous estradiol and put a couple of drops
under your tongue daily.  This may work and you can control
things yourself.

Phouser1:    What is the menopausal FSH level?  What is normal
FSH for a non menopausal woman?

 Dr. Alan Aven:           FSH is a pituitary hormone.  The pituitary
controls the ovaries (also the thyroid, adrenal gland,
etc.).  When the ovaries stop producing eggs, 
the estrogen level falls and the pituitary starts
"screaming" at the ovaries via the Follicle Stimulating
Hormone to make eggs (which of course it can't do), 
and the FSH level in the blood rises.  A value over 30
(usually) means menopause.

RCHCTH: What about severe allergies (still on shots for
30+ years) and HRT?

 Dr. Alan Aven:           Do the shots help your allergies?  If not,
food allergies may be the issues.  HRT can be used very
effectively, and you may even see an improvement in your
allergies.

RCHCTH: Yes, I'm under control as long as I get my shots. 
I just redid my serum from scratch last year.  I have been a
while getting it back under control with new stuff.  I am
concerned about an allergic reaction to HRT.

 Dr. Alan Aven:           One of my specialty interests is allergy and
I have only found a very few women who truly couldn't use
HRT due to reactions.  These women handle their symptoms
well with vitamin therapy and other methods.

RCHCTH: Thank you, I am in vitamins now.

Jbuck1:      Do you have to wait until there is no menses
to be treated for hot flashes?

 Dr. Alan Aven:           Vitamin E handles the flushes well but HRT
can be started at anytime.  To use HRT is a quality of life
issue (as I have said before).  If life is okay with
menopause symptoms, then why bother to treat them, unless
there are risks that wish to be avoided like osteoporosis,
shrinking of the vagina, etc.

Dearest:     Allan, I've asked you all the medical
questions during your many visits to Power Surge, but
there's one thing I haven't asked about and I know many of
these women have the same experience as myself and that has 
to do with what happens to the elasticity in our skin?
(especially our breasts) Is there anything we can do to
improve sagging breasts?

 Dr. Alan Aven:           It is a problem not just with the breasts,
but the neck, arms,butt, thighs as well.  It's an aging
process and I believe that the answer might lie in
nutrition, as using more vitamin A.  It's not something that
I have given a great deal of thought to, but check back with
me in a few months.  I might have some ideas.

Syrndipity:  Are there any studies on DES daughters and
their problems going through menopause?

 Dr. Alan Aven:           I have several DES daughters in my practice
and they don't seem to have anything unusual, just constant
watching.

NitaFar:          Can blood pressure problems occur during
menopause as the estrogen decreases?

 Dr. Alan Aven:           This is multifactorial.  One must look at
weight vs. height, diet, and heredity.  Of course, too much
estrogen can elevate the pressure by increasing the blood
volume and by fluid retention.

TISHWEAVER:  I'm peri-menopausal and I have very heavy
clotting with my periods.  What would you suggest to help
control this?  My doctor refuses to test my hormone levels
until I stop having periods.

 Dr. Alan Aven:           This is one of the most common signs of
perimenopause.  Some women do very well with low dose birth
control pills, like Loestrin 1/2.0, or even the progesterone
only pills.  However, watch for anemia.  Periodic checks of
the endometrial lining by biopsy and ultrasound are probably 
important also.  If it gets really bad, sometimes "they"
talk about hysterectomy.

Batchika2:   What do you think of B-12 shots?  Do you
prescribe it for anything besides anemia?

 Dr. Alan Aven:           There isn't an insurance company around that
pays for B-1. I have seen B-12 shots help many people
improve the quality of their lives so I show them how to do
it themselves!

Batchika2:   Do the shots cost a lot?

 Dr. Alan Aven:    A month's supply of B-12 costs about $1.50.

Dearest:     Many of the newsletters have information
about HRT and natural progesterone.  Email me if you want
directions to the Web site's newsletters reading room.

Member2:     I'd like your opinion of natural estrogen derived
from the plant.  I am currently on it after hysterectomy.

 Dr. Alan Aven:    Member2, there are no really good long term
studies showing if natural estrogen is all that good; and
personally, I wonder who controls the companies that
manufacture it?

Batchika2:   B-12, what does it do?  What is name of serum
you prescribe?

 Dr. Alan Aven:           Traditionally, it's a very important factor
in red blood cell production.  Off the record, it improves
the sense of well-being and can stimulate the appetite in
older folks.

One1Dot:     Food appetite or desire appetite?

 Dr. Alan Aven:           Food, B-6 tends to improve "desire."

SDillon856:  What would a doctor be looking for if he does
a testosterone test on a woman who has had a hysterectomy?

 Dr. Alan Aven:           SD, from NAMS:  they advocate testosterone in
women who have had a hysterectomy because the ovaries, if
removed (and they usually are), make a certain necessary
amount of this hormone.  If the "normal" level of
testosterone drops, then replacement is important to
maintain a feeling of well-being and the sex drive.

MsLizzieB:   Just wondering: how common is it for periods
to just stop suddenly at menopause?

 Dr. Alan Aven:           Lizzie, that's what menopause is!

MsLizzieB:   I meant, as opposed to tapering off or being
irregular over years.

 Dr. Alan Aven:           For every woman, there is an individual
pattern unto herself!

Member2:     Is testosterone an accepted remedy for decreased
sex drive in women?

Dearest:     Many articles about testosterone in the
newsletters.  Have a look.

Batchika2:   What is a "normal" reading of testosterone in
women?  When would you add it?  Will it make me bald?

 Dr. Alan Aven:           I wouldn't jump right into testosterone for
sex drive before trying B complex and a discussion about the
home situation.  I was trying to find the actual number for
testosterone in women but don't have a ready reference here. 
The replacement dose would have to exceed about 25 mg a 
day to cause severe masculinization.

Syrndipity:  This may not be exactly related to menopause,
but could be in the future.  My niece has genital warts. 
Will she have to be careful during menopause because of
them?

 Dr. Alan Aven:           The warts should be removed by whatever means
works, then they will not be a problem during menopause.

Member1:     I no longer have any desire for sex at age 50.  I
have been taking Estratest for 1 1/2 to 2 years.  It doesn't
really help.  I also take Paxil.

 Dr. Alan Aven:           Sounds like you may need either more estrogen
and or more testosterone.  Paxil totally kills any sex drive
that anyone ever had.

Member1:     So should I stop the Paxil?  I've been on either
Paxil or Prozac for 4 years now.

 Dr. Alan Aven:           That whole class of antidepressants does the
same thing.

One1Dot:          Does the pineal gland have a role in
menopause?

 Dr. Alan Aven:           The pineal gland is not well understood so I
really don't know how it relates, if at all, to menopause.

Member2:     What about Welbutrin and the sex drive:  is there
any connection?  I have had a major depression.

Dearest:     Member2, read all about it in the newsletters
in the Melatonin article.

 Dr. Alan Aven:           As far as Welbutrin, remember that drugs are
chemicals and can do just about anything to the body by
altering its normal function.  So, that answer is yes.

Dearest:     Oftentimes, more harm than good.

SMartin992:  Dr., are there any antidepressants that don't
effect the sex drive?

 Dr. Alan Aven:           B-complex!  The older tricyclics like Elavil
are less likely, but they can still do it.

SMartin992:  Do you mean B-6 or B-complex?  I'm a bit
confused about all the B vitamins.

 Dr. Alan Aven:           I totally agree with your feelings, too.  SM,
I'd try the whole B-complex.

D Wintrode:  I am 36 and I had a hysterectomy a year ago. 
The life has gone out of me.  Do I have testosterone
receptors?

 Dr. Alan Aven:           DW, hysterectomies are a shock to the body
and can contribute to other problems that may already be
starting, like thyroid dysfunction, ulcers, etc.  I suggest
you get a complete physical and not blame the hysterectomy
yet.

Batchika2:   How common is depression with menopause?

Dearest:     Batch, depression is *very* common during
menopause.  You must read the newsletter with a fabulous
article about depression.  Send me E-mail and I'll tell you
which one.

Dearest:     Okay, I think we've come to the end of the Q  & A 
segment  with Dr. Allan.  Doc Allan, thanks so much for spending this
time answering our questions in your marvelous way.  This  has been 
a very enlightening evening, and we all thank you for joining us in 
Power Surge tonight.  We hope you'll come back to guest in Power Surge 
again very soon!

 Dr. Alan Aven:           Don't be afraid to e-mail me with your questions.

Dearest:     How many of you have found your lives have
changed since menopause began?  SM, I don't believe in
medications unless they're necessary for survival so I use
good eating habits.  Exercise is excellent for depression. 
I take lots of vitamins.

Member1:     I really like how I feel and behave better on
medications and would stay on them forever but somehow, I
feel it's not right.

Dearest:     Member1, the decision to take HRT and any
medication is a very individual one.

Batchika2:   Sometimes nothing works.

Member2:     I am better now Dearest and Member1, but I am on
Welbutrin and estrogen. I've tried all else.  Member1, don't
give up.  It's been a long road for me, but I'm getting
better.

Dearest:     How many of you feel a sense of anger you've
never felt before? Let me impress one thing on you gals, and
this is very important, I thought I'd be as I was a year ago
for the rest of my life, but it DOES IMPROVE.

Batchika2:   Dearest, how many years have you been in the
menopause process?

Dearest:     Batch, it started with subtle changes, but
I'd say a good 5-6 years.  The last two have been the worst. 
Things have improved-- really.  We tend to discount the
beginning before the major hot flashes, insomnia, etc.  It's 
so much to cope with all at once.

Member2:     Thank you all so much it's nice not to be alone
out here. I have to go.  See you soon.

Dearest:     "Power Surge is sharing"

NitaFar:          The tears and anger were before the hot
flashes and insomnia for me.



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Dearest
aka Alice Stamm
Power Surge
Founder, Facilitator, Host


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