(Dr. Susan Love's Second visit to Power Surge)


OnlineHost:  " Dr. Susan Love's Breast Book changed the way women 
thought about breast cancer and helped launch a political movement.
Now the famous doctor, author, and advocate takes on menopause with 
 "Dr. Susan Love's Hormone Book." Power Surge and Thrive are proud 
to introduce Dr. Susan Love.


LiveOnstge: Hello everyone thank you for joining us in welcoming 
Dr. Susan Love:)


Dearest:  Dr. Love, a very warm welcome back to Power Surge and our
extended edition tonight in AOL Live's Auditorium. It's a pleasure to 
have you join us again :)


Dearest: Let me begin by asking, are we any less confused about the safety 
and efficacy of HRT (hormone replacement therapy) today than, 
say, three years ago? 


Dr. Susan Love: Well, not really maybe even more confused. But the good 
news is that there is a lot more research going on now and we will 
have more answers in the near future


Dearest: Thank you, Dr. Love. Let's take an audience question  :)


Comment: What do you think of "Natural Estrogen", such as is 
recommended in "Estrogen The Natural Way" by Nina Shandler?  
Is it a good method for protecting bones?

Dr. Susan Love:  Yes, there is a difference between "natural " estrogen that 
you can get compounded at special pharmacies and "natural" estrogen 
that you can get in food.   The kind that is found in soy for example 
is not exactly estrogen and is at a very low dose.  Nonetheless, it 
has been shown to be good for the bones,  decrease cholesterol and 
stop or decrease hot flashes.  It also has beneficial effects on 
breast cancer and may well prevent it.  All this with no down side. 
But this is for those women who are looking for prevention.  I would 
not use soy as my only treatment for osteoporosis for example.


Dearest: Dr. Love, a member of Power Surge mentioned that she's had 
breast cysts aspirated about  6-7 times in both breasts over the last 
10 years.  She wanted to know if someone with that history should 
take HRT. Lab tests, mammograms, ultrasounds are all okay.  Thanks.


Dr. Susan Love: Breast cysts are fluid filled sacs which occur in the breast 
of premenopausal women.  They do not increase the risk of breast 
cancer. They also go away completely with menopause unless you take 
HRT.  The question is why you want to take HRT. If it is for relief 
of the time limited symptoms of menopause then you have to decide whether 
the symptoms are worse than cysts.


Dr. Susan Love: If it is for prevention the rest of your life...then you have to
decide whether you want to keep having cysts or whether you
want to try another form of prevention.


Dearest: Thank you, Dr. Love. Let's go to the audience again for a 
question.


Comment: What strength Vivelle patch is equivalent to the .625 mg 
estrogen to obtain maximum bone protection -- .05 mg or ?


Dr. Susan Love: This is a good question and we do not really know the answer.
Recently we are finally seeing research on how much estrogen you really 
need to prevent osteoporosis.  To many people's surprise a recent study 
showed that .3 was as good as .625 of Premarin. But I am unaware of 
data on the patch.  It is not exactly the same as a pill because it is not 
metabolized  in the liver.  So you can't just take the information on  
Premarin and translate it directly.


Stay tuned ...more info is bound to come out soon.  Also a study just 
last week showed that estrogen without calcium had more less effect on 
bone density so don't forget the calcium and vitamin D.


Dearest:  What are your feelings about the new drug, Raloxifene, aka
Evista, which is supposed to provide the protection HRT does but not a 
remedy for the usual menopausal complaints?


Dr. Susan Love: This is a SERM or selective estrogen receptor modulator (I 
always remember it as sperm without the p!!).  Anyway it is designed 
to do all the good things and none of the bad As usual it isn't perfect.  
It will help bone density some but not as much as estrogen.  It helps 
cholesterol some but not as much as Premarin and may not help the 
blood vessels like Premarin. It does decrease breast cancer in two years 
of study...but Premarin takes five years to increase breast cancer so two 
years is not enough.  It may not help the brain and worst of all it causes 
hot flashes and vaginal dryness!!!!  Whenever something sounds too 
good to be true it usually is!!  Nonetheless, it is another option which 
may work for some women.        I think the more options we have the better. 
We just need to remember that there is a pharamceutical company who 
wants to make lots of money on it.  We need to take everything -- even 
information about estrogen with a grain of salt.


Comment:  I am a 21 year old female and recently I found a small lump 
on my breast and I was wondering what I should and if breast cancer is 
common is women my age.


Dr. Susan Love:  Breast cancer is very rare at your age although not impossible.
Lumps at your age are usually fibroadenomas. These are benign 
outgrowths of tissue which are not harmful.  You should get it checked 
out but I wouldn't worry too much


Dearest: Dr. Love, what is the difference between progestin and
progesterone?


Dr. Susan Love:  Good question.  Progesterone is a hormone which is made 
by the egg sac in the ovary after we ovulate.  It gets the body ready for 
pregnancy. That is why it is called Pro gest (pregnancy) terone. It is not 
normally present after menopause because we do not ovulate.


Dr. Susan Love: Progestin is a synthetic version of the natural hormone which 
has some of the same effect and some different ones.  Both are used to 
counteract the bad effects of estrogen on the uterus in postmenopausal 
women.  Progesterone is more "natural" (there is that word again) and
probably better for you but it is difficult to get and must be compounded 
specially.  

Dr. Susan Love:  Provera is the progestin used in this country and it is effective 
for the uterus but may block some of the good effects of estrogen.  I might 
add one of the benefits of Raloxifene that we mentioned earlier is that it 
does not stimulate the uterus as estrogen does and so you do not have to 
take a progestin or progesterone with it.


Dearest:  Thanks so much for that very comprehensive answer, Dr. Love. 
Let's go to the audience..


Comment:  What ar your true feelings about estratest?  What would you use 
instead of this drug?


Dr. Susan Love: I am worried about the use of testosterone.  We have very little
data on it.  It depends what you are using it for.  The main argument in 
its favor is libido for those women especially who had a hysterectomy 
and have no libido.  The dose needed is much less than that in estratest.  
I think we need to research how little you can take and still get an effect.


Dearest: Re testosterone therapy, Dr. Love... is it true that women can 
develop heart disease from taking testosterone therapy?


Dr. Susan Love: God only knows and she only talks to me once a week!


Dearest: LOL!


Dr. Susan Love: Actually there has been a little data from monkeys showing 
that cholesterol doesn't go up.  But it is known to be a factor in 
heart disease in men so the jury is still out!


Comment: Is there ever a safe time to take HRT if you have had breast 
cancer?


Dr. Susan Love:  I personally do not think so.  It is interesting that all of 
the risk factors for breast cancer have to do with estrogen and all 
the treatments work to decrease estrogen.  There is always the 
possiblitiy of cells lying dormant and I would hate to wake them up 
with estrogen


Dearest: Dr. Love, when talking about hormones, we hear a great deal
these days about receptors or SERMS. Can you simplify what SERMS 
are and how they work?


Dr. Susan Love:  This all started with Tamoxifen a drug that is used for breast
cancer.  It blocks estrogen in the breast and so we thought it would
block estrogen everywhere only to find out that it actually acted like 
estrogen in the bones, liver and uterus.  This told us that a drug could 
be like estrogen in some organs and block estrogen in others.   The 
pharmaceutical companies were off and running to design the perfect 
SERM and Raloxifene that we spoke about is the first.  But life is not 
so simple.


Dr. Susan Love: Turns out that there are actually two estrogen receptors not 
one as we had always thought.  Some drugs like Raloxifene or tamoxifen 
can block one and stimulate the other. The reason that this all seems 
confusing is that even the scientists are confused now.

Dr. Susan Love: This is really a work in progress and all I can say is stay tuned. 
The answer will come eventually!  The good news is that at least we are 
finally doing the research to get the answer. Excuse me while I have my 
hot flash...


Dearest: Dr. Love, this may be a little different from the type of question
you're accustomed to, but I'm sure many women are interested --  how is 
menopause treating YOU, and how are YOU treating menopause?  :)


Dr. Susan Love: I wasn't kidding a minute ago ...I am having a hot flash even 
as I type I am two weeks from fifty and in the throes of perimenopause. 
I take vitamin E,  multivitamins and eat some soy every day. In addition,
I am exercising five times a week and trying to watch my diet. So far so 
good.  I am not suffering enough to take drugs yet.


Dr. Susan Love: But I would not rule them out.  If it gets too bad I would take 
Premarin for three to five years and taper off gradually over 6-9 months. 
I don't think I will take it for prevention however, i would rather look to 
my lifestyle. I also think you have to laugh a lot and I have decided that 
chocolate is a vegetable!!!!  Since it comes from a bean...so I try to eat 
some every day!


Dearest: Why Premarin?


Dr. Susan Love: Because we know the most about it.


Comment:  Interested in information about the effects of Tamoxifen on 
the liver.  I had breast cancer and am now taking Tamoxifen.


Dr. Susan Love:  Tamoxifen has been shown to cause liver cancer in rats but 
as of yet not in women.  It does cause uterine cancer (1 in 1000) so if 
you have any bleeding check it out.  Tamoxifen taken for five years will 
decrease both the recurrence of breast cancer as well as the chance of 
getting it in the other breast.  It is worth taking for five years.
After five years the cells become resistant and it can actually 
increase breast cancer.


Dearest: Dr. Love,  are we deluding ourselves about natural products, 
i.e.,  thinking even natural progesterone creams made from wild yam 
extract are natural when they have to go thru laboratory processing, too?


Dr. Susan Love: I think everyone is using the word natural to serve their own 
purpose. "Natural " estrogens that are compounded have the same problems 
as Premarin does.  They can promote breast cancer and 
uterine cancer.  You have to decide first whether you want to take 
hormones for symptoms or prevention and the then decide which 
flavor you want to take ie the pregnant mare's urine flavor or the wild 
yam flavor.  but we are deluding ourselves if we think that just because 
it started out in a Yam and then was made into a hormone it is safer.


Dearest: Thanks, Dr. Love. Time has flown, unfortunately, so let's 
take one last question from the audience.


Comment:   There are many people who do not want to take HRT like myself.  
I am using soy products especialy soybeans so far so good 
your comments please I have controlled high blood pressure and 
varicose veins and do not want HRT.


Dr. Susan Love: I think soy products are a miracle food. They prevent high
cholesterol, increase bone density , decrease breast cancer, decrease 
hot flashes and decrease prostate cancer. I haven't found a downside . 
I eat a lot of soy myself.   I have even found a way to make a wonderful 
tofu chocolate pudding so that I can eat my soy and my vegetables 
together.

--------------------

Dearest note:  As a special treat to you readers out there, I'm including
the referenced Tofu Chocolate Pudding recipe originally found in
Nina Shandler's wonderful book, "Estrogen, The Natural Way" and 
posted on the Power Surge Message Boards (keyword: Powersurge@thrive) 
by Surgette, Carol (Kaaitjie) 



Tofu Chocolate Pudding Recipe

Yields 4 servings  (except for some of us)  :)
Takes five minutes to prepare
Takes one minute to eat

9 oz.silken tofu 
1/2 cup unsweetened cocoa powder  
1/4 cup maple syrup ( can substitute with corn syrup) 
1 tablespoon blackstrap unsulphured molasses 
1 tablespoon vanilla extract.  

Place all ingredients in food processor and process until smooth and creamy.  
Taste.  Add more vanilla if needed.  Serve or refrigerate.  

Some plant estrogen or calcium will be lost if you omit the maple syrup.

----------------------

Dearest:   Dr. Love, thanks for joining us again in Power Surge and so 
excellently fielding our many questions about menopause and hormones. 

Dearest:   I strongly recommend  "Dr. Susan Love's Hormone Book" 
and "Dr. Susan Love's Breast Book" (Random House) for every woman.  
If you're considering E-Mailing Dr. Love here on AOL, she asked that I mention 
that she regrets she doesn't check her AOL E-Mail on a regular basis.


LiveOnstge: Dr. Love, thanks so much on behalf on Thrive, Power 
Surge and Dearest -- another great forum! Good Night.


Dearest: Thanks, Dr. Love, for joining us in Power Surge. I look forward to 
your return again in the very near future. 


Dr. Susan Love:    My pleasure. I would love to come back


Dearest:   You have an open invitation, Susan :)

 
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Copyright 1998 America Online, Inc. All Rights Reserved.



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 with Dr. Love, Dr. Marcie Richardson and Dearest


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Dearest
aka Alice Stamm
Power Surge
Founder, Facilitator, Host


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