(Ruth Jacobowitz's 5th visit to Power Surge)

Dearest:   One of my greatest pleasures in Power Surge is bringing the extraordinary 
expert guests, who give of their time freely to visit with us and answer all our questions.  
One special guest is internationally renowned women's health expert and advocate, lecturer, 
medical journalist and author of the the wonderful, "The 150 Most-Asked Questions About . . . " 
series of books - individual books on the subjects of Menopause; Osteoporosis; Midlife 
Sex, Love and Intimacy and her newest, "The Estrogen Answer Book: The 150 
Most-Asked Questions About Hormone Replacement Therapy". . .  
RUTH JACOBOWITZ. Listed in Who's Who in the World and Who's Who in American Women, 
Ruth is a member of the most prestigious women's health organizations and has appeared 
as an expert on numerous national TV and radio shows. Ruth's articles appear in major 
newspapers and magazines.  She has a syndicated column, "Health Matters," and writes for 
"Your Health"  magazine and "The Chagrin Valley Times."

It's always great having you back, Ruth :)  In Power Surge we've discussed the Women's Health 
Initiative study. What can we look forward to learning in the year 2005 from the results of this 
important study, and how will it benefit those of us are likely to be post-menopausal?


Ruth Jacobowitz:   It's great to be back. I see by the names, we've got old friends and new.  I 
think the study will benefit us, but I think it will be disputed by scientists for a long 
while. So I don't think we are going to get finite answers soon. 


Dearest:    I wonder if we'll ever get finite answers. Anyway, it's great having you back. 
Let's go to the queue of questions waiting :)  Mismary, go ahead, please.


Mismary157:   What do you know about Remifemin and Promensil?


Ruth Jacobowitz:   I know that Promensil has some good studies behind it. It's made from red 
clover and seems to be the best of the plant source therapies. 


MrsMeister:   Ruth, what do you feel is the best way to determine a woman’s HRT 
treatment?  Are some women intolerant of any form of HRT and why? Thanks.


Ruth Jacobowitz:   I think trial and error might be the best method. In my book I list the 28, yes 
28, different kinds of estrogen. All estrogens are not the same. You start with what your 
doctor deems best, but be knowledgeable and empowered to tell her/him what you'd like to 
try if your HRT is not working perfectly for you. 


Dearest:    Ruth, your table of commonly prescribed estrogens and progestins/progesterones 
is wonderful. I've turned it into a table for the Web site. I thought you'd be pleased to 
know :) I've never seen such a comprehensive list.


Ruth Jacobowitz:   I also want to mention that there is a new natural oral micronized progesterone 
called Prometrium that gets rid of lots of the side effects of Provera. Thank for the 
nice compliment, Dearest. 


Dearest:    You're most welcome :)  Emoli, go ahead, please.


Emoli:   What effect does estrogen have on epilepsy and/or breast cancer?  


Ruth Jacobowitz:   Good question. Difficult answers. Some individuals with epilepsy have no 
problem with estrogen; others do. That's a question for your doctor. In terms of breast 
cancer it depends on whether the tumor was estrogen dependent or not. 



PianoMary:   What are your feelings about soy  - not only to help with menopause 
symptoms, but also to protect against heart disease and osteoporosis? 


Ruth Jacobowitz:   I think soy may turn out to be a "magic bullet" There are not sufficient 
studies completed yet, but they are underway. You can't go wrong adding some soy to your 
diet. In Asia, women consume about 100 mg. of soy per day; in the US we consumer 1 to 3 
mg. So upping your soy intake is a good idea.


Dearest:    Ruth, I brought my cholesterol down by over 100 points with Revival.


Ruth Jacobowitz:   I know it can do that and it's wonderful. 


Lily405025:   I took Premarin for 2 weeks and my fibroid grew.  What else can I try?  
Also, I have fibromyalgia and Chronic Fatigue Syndrome.


Ruth Jacobowitz:  Complicated! I think you might wish to try something like Evista which 
protects your bones, and lowers your cholesterol, therefore it has good effect upon the 
heart, but does not enter the uterus or breast. It also doesn't stop hot flashes, but you can 
deal with them often with Vitamin E. In term of vaginal atrophy an over the counter 
moisturizer like Astroglide or Replens helps and there is also an estrogen ring called 
Estring that helps geniturinary problems. 


Dearest:    Ruth, we're constantly hearing talk of "estrogen dominance," and the 
importance of balancing estrogen and progesterone by people such as Dr. John Lee. Scores 
of women are using natural plant estrogens via soy isoflavones, such as Revival soy 
protein, but are not supplementing progesterone. Do you recommend these women use 
supplemental progesterone as well?


Ruth Jacobowitz:   I think if a woman has her uterus intact, she needs both estrogen and 
progesterone if she's had a hysterectomy, estrogen alone usually does the trick. As you 
know, in the book I went into detail about plant sources of hormones as well as 
pharmaceuticals.  We women need to know all that's out there and then make our own 
decisions. 


TKWill18:   I had a total hysterectomy and I'm using the Vivelle patch. I have real bad 
depression and my Doctor doesn't think it is related to the surgery.


Dearest:    <she's 26 years old, Ruth>


Ruth Jacobowitz:   Vivelle is an excellent patch. There is now a new Vivelle called the Vivelle 
dot; it the size of a nickel. Depression is not uncommon after a total hysterectomy. Has 
your physician checked to make sure you are getting enough estrogen. A simple blood test 
will do, especially with a patch. You know many studies have shown the estrogen has a 
mental tonic effect. So I would check it out to see if your estrogen levels are high 
enough. 


Dearest:    Ruth, her doctor told her her reactions are not due to the hysterectomy and 
has sent her for a psychiatric evaluation :(  She can't seem to get any answers.  She's 
26 years old and beside herself.  Can we help her?


Ruth Jacobowitz:   I'm very sorry to hear that. I wonder if a second opinion from another doctor 
is in order. 


Dearest:    I certainly think so. Tammy, would you like to share more?  I'll get back to 
the queue in a moment. This young woman is having a hell of a time.  Thank you.


TKWill18:   Thank you, I'm fine. 


Dearest:    Ok, you sure?


TKWill18:   Yes.


Ruth Jacobowitz:   TK, please feel free to contact me directly through Dearest if I can help. 


Dearest:    Thank you, Ruth.  Ok. Good :)  Peg, go ahead.


PZukow:   The number one herb or vitamin most important during perimenopause would be? 


Ruth Jacobowitz:   Probably Vitamin E and a good multi-vitamin besides. B-6 helps with bloating.  
There are so very many. Gingko seems to help with memory. I could go on and on. 


Dearest:    How accurate are FSH (follicle stimulating hormone) levels? Is there a 
specific time of the month that's better to take this test? Also, how do the blood tests 
compare to the saliva tests?


Ruth Jacobowitz:   I feel more confident with the blood test. I think it should be done more than 
once.  Certainly in the first two weeks of your former cycle and again about a week after 
when you have had or would have had a period. If these differ, you might need a third. 


Dearest:    Thanks so much, Ruth. Mayo, go ahead, please.


Mayo3232:   I know you are a grandmother of many who is your favorite grandchild and why? 


Ruth Jacobowitz:   That's too tough, Mayo. I have 8, four boys and four girls and they are all my 
favorites. 


Dearest:    Oh, by the way, Ruth. I forgot to tell you. My daughter had a baby boy last 
Monday night - Jake :)


Ruth Jacobowitz:   Congratulations! I have a Jake, too--he's 7. How much did Jake weigh and how is 
your daughter? 


Dearest:    9 lbs. 1 oz :)  My daughter is fine, thanks :)  And all Jake's are wonderful :)


Dearest:    Kitkat, please go ahead :)


Kitkat4888:   Which estrogen is most compatible with the human body?  I have heard 
Premarin doesn't always work so great, that Estrace is better, what is your opinion? 


Ruth Jacobowitz:   Estrace is made from Betadiol 17 and is more like the estrogen your own body 
was making. 


Emoli:   Are there any other hormones other than estrogen/progesterone that effect 
menopause?  If so, what are they?


Ruth Jacobowitz:   Sure. Testosterone is the hormone of desire and often women lose it when they 
lose estrogen and progesterone resulting in lack of libido, excessive fatigue, etc. 


Dearest:    Visit Power Surge at keyword: ages and stages. On the Web at 
www.power-surge.com


Cheryl1083:   I have recently been diagnosed with breast cancer - estrogen dependent. 
Does that mean I can never use HRT? 


Ruth Jacobowitz:   It may. But you can use Evista, a synthetic estrogen compound made by Eli Lilly 
Company. It helps bones and hearts (though not quite as well as estrogen), but does not 
enter the estrogen receptors of the breast or uterus. 


Dearest:    If I might add, you can also use Revival Soy Protein, loaded with natural 
plant estrogens and used at Johns Hopkins to treat women with breast cancer and at high 
risk for breast cancer.  Email me for info if you're interested.  JDCJL, go ahead, 
please.


JDCJL25:   What is the average age to experience menopause?  


Ruth Jacobowitz:   Good Question. The average age is 51.  Thanks Dearest, I should have mentioned 
Revival. 


Dearest:    No problem, Ruth.  Doolphinn, go ahead please.


Doolphinn:   Why does a women need progesterone if she has her uterus?


Ruth Jacobowitz:   Progesterone protects the uterus by not enabling its lining, called the 
endometrium from building up in a condition called Endometrial Hyperplasia, which can be 
a precancerous situation. 


Dearest:    Ruth, plain and simple, what conditions and/or circumstances contraindicate 
the use of hormone replacement therapy in some women?


Ruth Jacobowitz:   Often gallstones, blood clots, and cancer contraindicate the use of hormones. 


Dearest:    Thanks, Ruth. Sally, go ahead, please :)


Sally1019:   If someone wanted to switch from Premarin (after one year) to Revival Soy 
Protein, how would you suggest the best way to taper off the Premarin? 


Ruth Jacobowitz:   Taper off very carefully and slowly. Perhaps the first week giving up the 
Monday pill; the second week the Wednesday pill, etc. Or begin alternately using a half a 
tablet on alternate days and then only two or three a week, etc. It is important to 
taper; never stop abruptly. 


Dearest:    Sea, do you remember your question? :)  If so, go ahead.


O SEAPEARL:   Does memory fog go away..?  I almost forgot it Dearest <G>


Dearest:    :)


Ruth Jacobowitz:   There is some thought that after a couple of years the fog lifts. 


Dearest:    Meladonna, go ahead, please.


MELADONNA:   What can be done for the libido and are men are prone to NO desire after a certain age?


Ruth Jacobowitz:   Big subject. If lack of libido is caused by lack of testosterone in women then 
a little testosterone added to your "hormone cocktail" will probably help greatly. In 
terms of men, I think they have their own set of mid-life issues and I am not an expert 
on them. Sorry. 


MELADONNA:   If I just take Revival should I add testosterone?


Ruth Jacobowitz:   That's a questions for your physician. Most doctors say you can take 
testosterone IF you are on estrogen. 


Dearest:    However, Ruth has a wonderful book called, 
"150 Most-Asked Questions About Midlife Sex, Love & Intimacy".
I strongly recommend it :)


MELADONNA:   Thank you. 


Dearest:    Kwech, go ahead, please.


Kwech:    I have had a total hysterectomy and hypothyroid.  I have had death thoughts and 
many other symptoms. I have been taking synthroid premarin alprazplam prozac this is not 
helping me, what can I do?


Ruth Jacobowitz:   Have you talked this over with a therapist?


Dearest:    Alprazolam and prozac?


Kwech:   No 


Dearest:    Why don't you see another doctor? Maybe you're taking too much medication.


Ruth Jacobowitz:   I think you need to consider doing that. Perhaps your doctor could suggest one. 
Also I agree you are on a lot of medications. Maybe a second opinion is in order. 


Kwech:   I have been to several specialists. 


Dearest:    Prozac is an anti-depressant and I believe Alprazolam is Valium and is known 
to cause depression.  Kwech, will you email me?  Mary, go ahead, please.



Mary5247:   Is sudden insecurity in your relationship normal?  I find myself paranoid 
about what my husband is doing.  I think it's unreasonable of me.  


Ruth Jacobowitz:   Normal is a loaded word. Sometimes we are all insecure, but if it persists, I 
would talk to a qualified therapist. 



O SEAPEARL:   I am enjoying my increased libido for the past 4 years.  Do all women lose 
it after menopause?  But I can't remember a thing <G>


Ruth Jacobowitz:   No. Often women report enhanced libido and you are one of them. It all depends 
on the hormone balance in your own body. 


Dearest:    Obviously, your memory isn't that bad, Sea. You remember the good sex enough 
to want more :)


Ruth Jacobowitz:   Remembering is another story. often estrogen is a big help. 



Spud0812:   What is your opinion of Revival Soy?


Ruth Jacobowitz:   I think it may be a good option. There are many options and women have 
to decide what to take. 


Emoli:   I have catamenial type seizures along with having had Breast Cancer since both 
are hormone driven is there any one that could be deficient? 


Ruth Jacobowitz:   I am not an expert in this area.  Sorry. 


Dearest:    Emoli, you may want to do a search on the Internet or E.mail me and I'll see if 
I can find more info for you.


Dearest:    Ruth, as a final question, can you explain about how soy isoflavones attach to 
our bodies own estrogen receptors, yet are not so strong as to activate those receptors 
so the effect anti-estrogenic.  It's confusing.  Can you shed some light on how this 
works? Thanks.


Ruth Jacobowitz:   Dear Dearest, That is confusing. But what soy can do is actually block the 
estrogen receptors so that our bodies own circulating estrogen does not/can not enter 
them. 


Dearest:    And how, then, can soy isoflavones actually protect us from breast cancer?  


Ruth Jacobowitz:   If we had more time I could go through the actual process.  When the receptors 
are blocked, estrogen cannot enter them. 


Dearest:    Ok. gotcha!  :) Thanks!

Ruth, thank you SO much for the usual informative and stimulating chat. I include Ruth's
books among Power Surge's "Top 10 Books for women in menopause" and you can locate 
them all in the  bookstore .  You will be linked directly to all of Ruth's wonderful books, 
including her newest, "The Estrogen Answer Book: The 150 Most-Asked Questions
 About Hormone Replacement Therapy", as well as from all of her transcripts in the 
Power Surge Library at: www.power-surge.com/library.htm.  Also, don't forget to visit 
Ruth's Web site at ww.ruthjacobowitz.com and Ruth invites you to  E.Mail her  anytime.


Dearest:   Ruth, let's plan for you to return again soon. You know you have an 
open invitation to Power Surge :)


Ruth Jacobowitz:   Dearest, I'll come on any time you ask me. I loved being with you all. 
Dearest does such a wonderful job of bringing us all together to help each other. I am 
ever in her debt.


Dearest:   That's so kind of you. We're both trying to help women through this difficult
transition. That's what it's all about :)


Sally1019:   Dearest has been a blessing to a lot of us :)


PianoMary:   That's for sure :)


Dearest:   Thanks and goodnight to our guest, Ruth Jacobowitz, and to all of you who
attended tonight's Power Surge Live! guest chat.
 

Ruth Jacobowitz:   Lots of love, great respect for the job you do. 


Dearest:  Thank you, and I for you!

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Dearest
aka Alice Stamm
Power Surge
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