(Dr. Lonnie Barbach's 2nd visit) 

Dearest:    First published in 1993, "The Pause" has changed the way we look at menopause -- 
showing women how to transform this time of hormonal transition into some of the most 
productive and fulfilling years of their lives.  Because of the significant amount of new 
research since the original book, my guest tonight, best selling author .....

                                    D R.   L O N N I E     B A R B A C H 

has completely updated her groundbreaking classic.  Not only does The Pause  address women's 
issues at menopause, but their significant others and the impact menopause will have on them 
as well. 

Lonnie talks about SERMs, phytoestrogens, and the impact of menopause on the female immune 
system, mood, weight gain, breast cancer survivors taking estrogen, the positive effect of 
estrogen on dementia and Alzheimer's, and new alternatives to traditional HRT, improving 
bone density, and assisting breast cancer survivors. Lonnie also addresses the problems of rage 
and depression and loss of libido -- issues frequently coming up in Power Surge.  

The best selling author of "For Yourself" and "For Each Other" has been profiled extensively 
in all of the major women's magazines, and is well known on the lecture circuit and for her 
frequent television appearances. She has enjoyed great success with her erotica collections 
Pleasures, Erotic Interludes, and The Erotic Edge.

Lonnie, welcome back to Power Surge.  In the four years since your first visit, what do you 
believe to be the most significant finding regarding menopause and women's health during 
this transition?  


Dr. Lonnie Barbach:   Probably the most important new information is what we have learned 
about phytoestrogens these are plant estrogens that help with menopausal symptoms and 
also protect against heart disease osteoporosis, and breast cancer.  Soy products are high 
in these phytoestrogens, so is ground flax seed and garbonzo beans. 


Dearest:    What about the recent study that said that plant estrogens too high in soy i
isoflavones can contribute to breast cancer?  I was always under the impression that the 
more soy isoflavones we used, the greater the protection against breast cancer. 


Dr. Lonnie Barbach:   I don't know about that particular study, but moderation is always 
the key.  I don't know how much isoflavones these women in the study were given.


Dearest:    Isn't it true, though, that soy isoflavones have anti-estrogenic effects? 


Dr. Lonnie Barbach:   Isoflavones appear to have an estrogenic effect on certain organs 
and anti-estrogenic on others.  Like SERMS.  There is a product called Promensil made from 
red clover which is high in isoflavones that helps some women with menopausal symptoms.  
Research is being done on the product now.  Also, the isoflavones genestein and diazene 
are the most important in protection against breast cancer.


Dearest:    Thanks, Lonnie. Let's go to the queue. Wrdwielder, please go ahead with your 
question for Dr. Lonnie Barbach. 


Wrdwielder:   Hello, Dr, Barbach - I'm a big fan of your earlier books. I just need to read 
"The Pause."  


Dr. Lonnie Barbach:   Thank you


Wrdwielder:   My question: does menopause affect lipid levels?  I have hyperlipidemia, and 
my lipid levels have suddenly gone way high after being under control for several years.   


Dr. Lonnie Barbach:   It appears that heart disease rises in women after menopause.  Estrogen 
plays some role in that it protect the elasticity of the arteries and keeps plaque from building.  
In some women, lipid levels also rise and estrogen taken orally tends to have the most i
immediate effect on this. 


Wrdwielder:   Thanks!  


MELADONNA:   What is good for the libido?  I take soy products.  Need some good advice.


Dr. Lonnie Barbach:   Lots of things affect libido.  If you are not feeling well and have 
symptoms like hot flashes and fatigue, estrogen or an alternative such as homeopathy, herbs, 
soy products or acupuncture that helps with the symptoms will help you feel more turned on 
because you'll feel better.  However, testosterone is really the hormone of sexual desire 
and it is possible to supplement with testosterone if your level is too low.  Some women 
on estrogen experience lowered desire because estrogen actually ties up some of the free 
testosterone and makes it unusable.  This is pretty new information.  Small doses of 
testosterone taken with estrogen is now being recommended for this problem. 


MELADONNA:   Thank you


Dearest:    Lonnie, would you like to share that information about the study in San Francisco? 
Seems appropriate after the libido question.


Dr. Lonnie Barbach:   Right.  We are doing a study in San Francisco for women who have low 
arousal and difficulty reaching orgasm.  The problem needs to be a change in ability to get 
aroused  You also much be post menopausal and in a stable relationship of over 6 months - 
heterosexual or lesbian.   Please call 415-202-0274 and ask for Julie. 


MrsMeister:   Why can some women not tolerate natural or synthetic exogenous hormones?


Dr. Lonnie Barbach:   We are all different.  Some women are more sensitive than others to 
things they ingest.  In fact, while estrogen helps most women who feel depressed during 
menopause, it will cause about 10% of women to feel depressed.  There is no one right 
approach to any problem that will work for every person.  We need to experiment to find 
something that works for us.  I'm quite sensitive and it took me awhile to find some 
approaches that solved the symptoms I was having.  


MrsMeister:   Thanks. Progesterone in any form has been like a poison.


LinWeeksRE:   Do you have suggestions for hair loss related to menopause/estrogen levels?


Dr. Lonnie Barbach:   Hair loss - there are a few things to try.  Homeopathy can help some 
women, so can acupuncture and Chinese herbs.  Estrogen can be helpful and so can taking 
an anti-testosterone medication plus Rogaine.  Rogaine is used by men for hair loss.  
Sometimes it is too high testosterone that causes the hair loss.  


PWPJWILL:   What are your credentials, doctor? MD? PhD? Gynecologist? There are suddenly 
many experts. 


Dr. Lonnie Barbach:   My credentials - I am a Ph.D. psychologist.  I got the medical information 
from consultations with experts and attending the North American Menopause Society Annual 
Meetings. 


PWPJWILL:   That's good to know 


Suburban M:   What causes a hot flash? Lack of Estrogen, or Progesterone causing estrogen 
dominance?  Also what has worked for you?


Dr. Lonnie Barbach:   There are a lot of theories about hot flashes and hence a number of 
things that will work for them.  Estrogen is absolutely helpful for most women.  But there 
is research showing that very deep abdominal breathing using biofeedback is also helpful.  
You can slow down your hot flashes at night if you turn up the temperature in your home or 
bedroom about an hour before you go to bed.  You are likely to get more hot flashes during 
this hour, but far fewer during the night.  Exercise is also helpful in preventing hot flashes.  
Vitamin E helps.


Dearest:    Lonnie, many men write to me unable to cope with their wives'  changes. I refer 
them to your book because yours is the only one I know of to date that has a chapter 
addressing the issues of the significant others of women in menopause. What do you 
recommend to the women here in menopause regarding how to talk about menopause to 
the men in their lives? 


Dr. Lonnie Barbach:   The last chapter in THE PAUSE is written to men.  Most men won't read 
a book on menopause, but they'll read a chapter and it is helpful for them to understand 
what their woman is going through.  Advice includes asking her each day how she is doing 
and for her to give him a daily "weather report" regarding mood and symptoms.  Take her out 
to exercise or help her with activities so she can find time to exercise.  Practical things 
like that.


OKNYTX:   Is there anything you can take to increase your sex drive?


Dr. Lonnie Barbach:   As I said before, testosterone either in pill form or in a cream that 
is rubbed on the labia or inner thigh depending on the type of cream.


OKNYTX:   Is it safe?


Dr. Lonnie Barbach:   The herb chasteberry (vitex) can also be helpful.  Sometimes lack of 
interest in sex has to do with problems in the relationship.  After a number of years couples 
tend to take one another for granted, resentments and unresolved issues mount.  Dealing with 
the relationship problems can have a positive effect on sexual interest.  Never stop the 
courting.  Tomorrow, Valentine's Day, can be kept in mind every day.   


OKNYTX:   Not on your life.  He is wonderful.  I had a hysterectomy and I have not been the 
same!


Dr. Lonnie Barbach:   Did you have your ovaries out?


OKNYTX:   Yes


Dr. Lonnie Barbach:   Then you can benefit from testosterone.  Testosterone is also manufactured 
in the ovaries and when the ovaries are taken out, the amount you are left with that is produced 
in the adrenals may be too little to support what you need for sexual interest.  That is why 
it is important not to have your ovaries out unnecessarily - like because you need your uterus 
out but "as long as they are going in" it's easy to take the ovaries out too, to protect 
you against ovarian cancer -- which is quite rare in women. 


OKNYTX:   Thank you  


Dearest:    Is it my imagination, Lonnie, or are they back to overdoing hysterectomies again?  


Dr. Lonnie Barbach:   They have always been into overdoing them.  For women with heavy 
bleeding, I have found that acupuncture can be extremely helpful.  It can help women with 
fibroids as well. 


LinWeeksRE:   Is declining muscle tone normal in menopause? 


Dr. Lonnie Barbach:   What happens is that women tend to exercise less as they get older 
and some of this has been blamed on menopause, but research seems to show that most of it 
is not due to menopause.  There does seem to be more difficulty losing weight and a tendency 
to gain weight during this time.  It turns out that estrogen is manufactured in the fat cells 
and I think women are naturally adapting to lowered levels of estrogen by creating more fat 
cells to boost their estrogen.  


LinWeeksRE:   Thanks


LORACURA:   What are your feelings about how long a woman needs to take HRT?  The rest 
of her life? 


Dr. Lonnie Barbach:   It depends on why you are taking it.  You can take it for a few years 
to handle symptoms that occur during the Pause.  You can take it for prevention of dementia, 
heart disease or osteoporosis.  If you are taking it for prevention you should continue taking 
it.  The problem is that breast cancer rates increase after about 5 years and even more so 
after 12 years.  The increase is not much, maybe 7 women more per thousand per year will 
get breast cancer who are on estrogen versus those that are not.  Soon, however, they will 
design a SERM.  This is a selective estrogen receptor modulator that will act as an estrogenic 
on the brain and bone and heart while anti-estrogenic on the uterus and breasts.  Until then, 
it is important to see what your risk factors are and take care of everything you can through 
diet and exercise and supplements.  If you don't want to take estrogen, there is a lot you can 
do to protect yourself against the above diseases.  If you do take estrogen, it is important 
to stay on it, women who took if for a few years in later years were better protected than 
women who had taken it for the same amount of time, but years earlier.  And you need it 
most as you get older. 


Dearest:    Lonnie, I hear so much from women in Power Surge about the horrific "RAGE" they 
feel during perimenopause, especially. Can you make any recommendations for this RAGE that 
often makes a menopausal woman feel totally out of control? 


Dr. Lonnie Barbach:   First, slow down on alcohol and sugar.  Make sure you get rest and 
are able to sleep.  Lack of estrogen can prevent sleep and this can cause some of the 
emotional problems you mentioned.  Vitamin B-6 about 200 mg per day can be helpful.  So 
can Promensil and soy products.  A woman friend of mine drank a box of soy milk every time 
she started to feel out of sorts.  It was the only thing that worked for her.  Chasteberry 
(vitex) can help, homeopathy can help and acupuncture done regularly during this time can 
be enormously helpful.  And of course there is estrogen.  For some women, natural progesterone 
cream will help them, but if their progesterone level is already too high this will increase the problem.  

By the way, there are great differences between types of progesterone, that I might just 
mention here.  You don't need to take any progesterone at all until you are having menstrual 
cycles that are longer than 2-3 months.  Provera, which is the progestin that most women 
were given made women feel homicidal or suicidal for a lot of women.  Now they haven natural 
micronized progesterone that you can take if you need to take a progesterone.  It actually 
helps you to sleep and Prometrium has come out and will be paid for by your health insurance.


Dearest:    Thanks, Lonnie. 


PianoMary:   How does turning UP the heat help reduce hot flashes while sleeping?  That 
sounds so contradictory.  


Dr. Lonnie Barbach:   I know, they don't know why it works.  Maybe you're allocated so many 
hot flashes and if you use them up before you go to sleep you'll have fewer left to use later.  
Just joking.  But it does work.


PianoMary:   LOL Thanks 


MELADONNA:   If husband is not willing to do anything about lack of interest? He won't take 
the prescription his Dr. gave him. There seem to be NO problems with our relationship.


Dr. Lonnie Barbach:   This is a tough one because your husband is not here.  I would need 
to know from him what is going on.  But I will venture a guess that you will find a cause.  
Sexual desire does not normally stop without a good reason.  I'm most curious about why he 
isn't taking the drug?  And what the drug was?  How old he is?  The other stresses in his 
life?, etc. 


MELADONNA:   I am curious too. He seems to just say he is not interested.  65 no drugs.  No 
stress. must be me :( Thanks.


Dearest:    Let me send that info to screen about the study, Lonnie.


Dr. Lonnie Barbach:   Ok


Dearest:    Lonnie has also asked me to share this with women in the San Francisco Bay Area.  
Sexually active women needed for a research study:  If you are over 18 years of age and are:  
Post-menopausal or post-hysterectomy  On hormone replacement, Experiencing low sexual 
arousal, Having difficulty experiencing orgasm, In a stable relationship, and have been for at 
least 6 months, Contact Julie at 415-202-0270 or 415-202-0274.    


XTeleDocx:   My problem with not having sex is that I have really lost the desire and then 
when we do, the next day I feel real bad and the hot flashes are worse. Is this common?


Dr. Lonnie Barbach:   I'd need to know more.  Are you getting aroused when you do make love?  
If you don't feel turned on, it can't be much fun, especially if you don't get turned on during.


XTeleDocx:   Sometimes, but not always.


Dr. Lonnie Barbach:   The hot flashes can be worse because of the stress of it all.  Testosterone 
might help you. See your doctor if he/she specializes in menopause. 


OKNYTX:   How do you feel about natural RX estrogens such as Bi-est (bi-estrogen)?


Dr. Lonnie Barbach:   I take something like that.  No good research on it.  But it depends 
on what makes you feel best.  We are still in the dark ages on all this stuff, unfortunately.  


OKNYTX:   It has saved my life.  I feel a lot better with it.


Cinda:   What is you've taken a saliva test and you know your estrogen is fine, but your 
progesterone is very low - and your periods are normal (once a month).  Should you take 
a natural progesterone creme? 


Dr. Lonnie Barbach:   Right now, saliva tests are a problem.  There are actually no norms 
yet for the results.  However, you could take some progesterone cream.  There are some you 
can get in health food stores. and see if you feel better. 


Dearest:    Lonnie, thank you for a fascinating and informative visit to Power Surge. Having 
read the original "The Pause: Positive Approaches to Menopause," and believing it impossible 
to improve upon, I must say that the revised, "The Pause: Positive Approaches to Perimenopause 
and Menopause" is even more comprehensive and a MUST-READ for every woman going 
through this transition. You can find THE PAUSE at amazon.com or on Power Surge's Reading List. 


Dr. Lonnie Barbach:  I've really enjoyed it.  





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