(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:      Other than assisting in libido problems, aren't there other areas 
in which testosterone supplementation is useful to menopausal women? I mean, 
we lose testosterone as we age, too -- something our bodies naturally produced 
for years, and why isn't testosterone traditionally part of a doctor's 
prescription for HRT? 


Ruth Jacobowitz:      Testosterone helps with libido, muscle maintenance, 
fatigue, and some say helps get rid of "menopause headaches." Yes we do have 
testosterone that so-called "male hormone" and we usually do lose it at 
menopause. 


Dearest:      Thanks, Ruth. PEPSILADY, GO AHEAD


PepsiLady:   To remove a small 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? 


Thinkin:   Yes, they suggested an endocrinologist.


Ruth Jacobowitz:      An endocrinologist is a good idea, but a nutritionist may 
help.


Dearest:      And probably cutting back on eating because weight loss is so 
difficult during this transition.


TSMedley:   I've had both ovaries removed. I was put on an estrace patch which 
did great except I was allergic to the adhesive. Now I'm on the same dose 
estrace pill, but finding I occasionally am having hot flashes and my skin is 
dry again. Is this normal for the pills? 


Ruth Jacobowitz:      Not normal, but can happen if your dose is too low? I would 
suggest upping the dose for a bit to see whether that gets rid of the hot 
flashes and the dry skin.


Karen:   I had the testosterone cream that you apply topically and used it for 
30 days then supposedly as needed.  I had absolutely NO results.  I haven't 
had a libido in 2 years!  My hubby thinks he should become a priest! LOL.  
What do I do now?  I am taking FemHrt for HRT and have been on it for about a 
year.


Ruth Jacobowitz:      The testosterone cream does not work for everyone. Talk to 
your doctor about the lozenges or pellets. 


Karen:   My Dr. retired


Ruth Jacobowitz:      Did someone take his/her place? 


Karen:   I'm in limbo because of insurance on that one 


Ruth Jacobowitz:      Well did he refer his patients to someone who is one your 
insurance plan? 


Karen:   She gave me names of several to choose from but since I just had my 
year "maintenance" done with her, no one will see me yet unless it is an 
emergency. 


Ruth Jacobowitz:      My dear Dearest, I'm going to have to sign off very soon, 
but of course I will take one last question. 


Dearest:      Thank you, dear Ruth :)


Ruth Jacobowitz:      I would call and say that it is an emergency for your 
marriage and I bet you'll be seen.  At least I would hope so.


Karen:   LOL ! I'll try that!  However, I'm blessed in that my hubby is very 
understanding! Thank you!


Thinkin:   Does anyone know if lozenges or pellets of testosterone interfere 
with HRT?


Ruth Jacobowitz:      No, they do not interfere with HRT. Often they enhance it. 


Thinkin:   Thank you. Going to buy your book this weekend!


Ruth Jacobowitz:      Great! 


Dearest:      Ruth, thanks so much for visiting with us again in Power Surge. 
It's always such a pleasure to have you here. Those of you who are familiar 
with Power Surge's most recommended books on menopause know that Ruth's 
books are included. You'll find them on this transcript when it's in 
the library and on her current transcripts. Thanks, again, for a very
informative and stimulating evening, Ruth. 


Ruth Jacobowitz:    It has been my pleasure to be here. Please invite me back 
soon. 



Read Ruth Jacobowitz's first transcript
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Read Ruth Jacobowitz's fifth transcript
Read Ruth Jacobowitz's sixth transcript



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Power Surge
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