(Dr. Elizabeth Lee Vliet's 2nd visit to Power Surge)

Dearest:   I'm pleased to welcome back to Power Surge doctor, lecturer, women's health care 
advocate, and author of the fascinating and informative bestseller,  "Screaming To BeHeard...."
"Screaming To Be Heard: Hormonal Connections Women Suspect . . . And Doctors 
Ignore," ... DR. ELIZABETH LEE VLIET.

Dr. Vliet is also the Founder and Director of HER Place® - The Women's Center for Health 
Enhancement and Renewal, Inc. in Dallas/Ft. Worth and Tucson. Dr. Vliet is on staff at 
Arizona College of Medicine and the University of North Texas Health Science Center. It 
would take a day to provide Dr. Vliet's credits, so I invite you to read her bio on the 
"Guests and  Advisors"  page of the Power Surge Web site.

How many of us must have heard at one time or another, "It's all in your head," or "It's your 
nerves!" or "Take a vacation."  How many of us have left our doctor's office feeling frustrated 
and lost.  Dr. Vliet will take us from out of that darkness and into the light, where  women 
have longed to be for ages.  With her forthright attitude and extraordinary knowledge, Dr. Vliet 
will answer ALL our greatest concerns about hormones!

A very warm welcome back to Power Surge, Dr. Vliet.  Before we get to the Question and Answer 
format, please feel free to make any opening statements you'd like :)


Dr. Elizabeth Lee Vliet: Thanks for the welcome! I look forward to being with the group again - 
you are all terrific! 


Dearest:  Thanks, and we're so pleased you've returned.  Then let's begin. PFWLJ,  go ahead.


PFWLJ:  If on HRT, how can you tell if menopause is OVER 


Dr. Elizabeth Lee Vliet:     By checking the FSH - if it is higher than 20, you are either 
in/through meno, or your hormone therapy is still too low!!!  I also recommend checking actual 
hormone levels.  


BColl38000:   I'm losing my hair, began when my periods stopped, what can I do? I just started 
Progest.


Dr. Elizabeth Lee Vliet:     Hair loss is a symptom of loss of estradiol and testosterone or of 
testosterone levels being too HIGH on supplements.  I would not expect PROGEST to have much effect 
on restoring your hair.  Have someone check your other hormone levels.  


Dearest:         Dr. Vliet, I wonder if you could give us a quick synopsis of the *natural*  hormones,  
Estrace, Estradial, as opposed to the *synthetic* hormones. Thanks  


Dr. Elizabeth Lee Vliet:   OK - will do.  Estradiol (E2) is the primary biologically active hormone 
"key" for   the body cells before menopause, and the estrogen that declines with meno.  Estrone (E1) 
is the estrogen made by the ovary, fat tissue and adrenal glands - present before and after meno.  

Natural sources of estradiol are soy precursors that are then purified in the lab to be the same 
molecule our ovaries make. Brand names of 17-beta estradiol in the U.S. are Climara (patch), Vivelle
( patch), Estrace (pills) and a new one FEM Patch. 
 
Synthetic to me means ones that are different compounds (different structure) from the hormones
our bodies make.  Non-human forms of estrogen in the U.S. are Premarin (derived from horses, and give 
mainly equine estrogens), PremPro, PremPhase, Estratest, Estrovis, Ogen, and others. Hope this 
helps!  


Dearest:   Yes, indeed. Thank you so much. Cesca, go ahead. 


CescaSF:        Can using 1/2 tsp per day of ProGest or 3 weeks affect my cycle?


Dr. Elizabeth Lee Vliet:     Yes, it can, since it only provides progesterone.  


RCHCTH: What do you think of Saliva Tests? My doctor thinks I'm nuts. Are they helpful? 


Dr. Elizabeth Lee Vliet:     Yes, they can be helpful. Saliva tests measure the FREE or active 
form of the hormone, and blood tests usually measure the total of bound and free.  I use both 
types of tests, depending on the situation.  


Wtchywmn:       Love your book! I am 32 , been on ERT for four years..am taking Estrace, Climara, 
and am having bad "brain fog". any sugesstions?


Dr. Elizabeth Lee Vliet:  BRAIN FOG is REAL and I find that it most often occurs if the estradiol 
level is too LOW or is dropping too quickly between doses.  Check your levels, and also remember :
that the patch wears off for some women before the manufacturer says it does!  Go by what your 
body is telling you!  



Chloecake:  Why can't I get methytestosterone in pill form,  not making it,  my saliva level of 
test is 25.


Dr. Elizabeth Lee Vliet:  You can get MT in pill or capsule form from a compounding pharmacist if 
you can't get it commercially.  The level of 25 seems high to me, but I would have to see the lab 
ranges.  


ARC23:  How can we best approach our physicians with the reccommendations in your book if he/she 
has not suggested these ideas to us first?  Thanks.  


Dr. Elizabeth Lee Vliet:  I think it helps to explain briefly why you would like the tests, and also 
let your doctor know that you want this information to help you decide about what symptoms may be due  
to hormone decline, and what symptoms may be due to other things.  Having the right lab tests is only 
common sense to make sure we as physicians know what we are trying to help with!!  And to see if we 
have achieved the benefits we are looking for. Also, I doubt that we would see many doctors fail 
to check such crucial labs if the patients were MEN with heart disease!.  WE WOMEN have to speak 
up and ask for what we feel is important to our health.  


Dearest:   Dr. Vliet, I took some questions from the Power Surge boards. Allison asks: "During 
perimenopause, when women complain of irregular menses, spotting, etc, why do physicians use low 
dose birth control pills? Since estradiol and micronized progesterone can be compounded in any 
strength and taken in any way, why can't these products be utilized instead? 


Dr. Elizabeth Lee Vliet:  They could be.  The problem is that the natural hormones are not 
contraceptive, and women in perimenopause are still fertile, although this is pretty unpredictable!  
My husband's mother had two surprise menopause babies at 48 and 49!  So contraception is one reason 
for the BCP, and another is to better minimize the CYCLIC symptoms that bother many women -- but I 
use whatever the woman prefers and what makes sense for her situation.  


Dearest:      Thank you.  Moondbeam, go ahead, please :)


Moondbeam:      Do you feel that Pro-Gest offers same benefits for osteo and heart as Premarin,
etc? 


Dr. Elizabeth Lee Vliet:  Definitely NOT.  ProGest only contains progesterone, and no estradiol. 
Worldwide research in multiple ethnic groups has clearly shown that it is primarily estradiol that 
preserves bone (especially when testosterone is also present), and estradiol has multiple functions 
to preserve normal heart and blood vessel function -- many different mechanisms, not just benefits on 
cholesterol.  Progesterone has not been shown in any reputable metabolic  research centers to have 
these same effects as estradiol.  I don't think Premarin provides the same degree of optimal 
benefit on cardiovascular and bone as do the 17-beta estradiol products I mentioned earlier, 
because Premarin gives very low blood levels of estradiol.  


Dearest:   Dr. Vliet, since HRT is digested and absorbed by the liver, would you recommend liver 
function tests before beginning HRT?  


Dr. Elizabeth Lee Vliet:     Good question - yes I ALWAYS do liver function tests before starting 
HRT, and suggest that women have these done.  But the good news is that the patch form (Climara and 
Vivelle) BYPASS the liver "first Pass" and put much less load on the liver.  Lots of benefits to this!  


Dearest:   Do women get the same benefits from the patch as from the oral HRT?  


Dr. Elizabeth Lee Vliet:   Yes, they do, and in my practice, we track these objective measures 
regularly - like bone density, urine bone markers, triglycerides, cholesterol, etc.  WE are finding 
BETTER results with the patch on all these.  And this fits with the worldwide literature as well.  I 
feel very comfortable the patch or any other form of non-oral delivery (vaginal, sublingual, cream,) 
that keeps levels in the natural range and fairly steady.  I don't use injections or implants because 
these give levels that are unpredictable and usually too high -- like a yo-yo.  


GUENWYVAR:      What do you think of herbal use over ERT?  I'm on Remifemin with some DonQuai & vitex. 
I had total Hyst April 2nd. Also est soy. Do these help protect against Alzheimers like ERT?  


Dr. Elizabeth Lee Vliet:     I think herbs can be fine if your bone density is great, and your 
cholesterol profile is also in the desirable range.  The key is to remember that hormones (whether 
from plant sources or the lab) are used for long-term effects as well as immediate symptom relief.  
Just make sure your you are not overlooking something like bone loss just because the symptoms are 
gone!  


Dr. Elizabeth Lee Vliet:     Also an added comment to ? about herbs protecting against Alzheimers.  
No evidence that the estrogenic effects are enough to do this.  For my brain, I want the REAL 
estradiol!!!  :)))  


MBarr227:       Periods heavy & now irregular -- TSH is erratic -- Is there a connection? My doctor 
says no.


Dr. Elizabeth Lee Vliet:  Yes, thyroid disorders are a common cause of menstrual irregularities, PMS, 
infertility, etc.  


Aquabebe2:      Do you find that SOME women get better results from Premarin than estradiol?


Dr. Elizabeth Lee Vliet:  Generally, no.  I would have to say honestly that in all my years of doing 
things, only two or three women out of several thousand I have treated have elected to go back to 
Premarin saying they felt better on it.  Have to go with what I find my patients tell me they like best.  


Mylady99:   Dr. Vliet, Ive been on Prempro for a while. Could I switch to the patch and still take 
Provera?


Dr. Elizabeth Lee Vliet:   You certainly can, but you might like natural progesterone even better than 
Provera - fewer side effects like weight gain, bloating, low libido, sweet cravings, fatigue, and    
depression that are often seen with Provera.  


Dearest:         Dr. Victoria Hufnagel....reported that Provera has been found to *cause* heart disease.
Have you heard of this?  


Dr. Elizabeth Lee Vliet:     Yes, and hypertension, insulin resistance, aggravation of diabetic control.  
I try to avoid using Provera in women who have other medical problems or who are at higher risk for 
heart disease.  Natural progesterone doesn't have these unwanted effects unless doses are too large, 
and levels of estradiol are too low.  


Dearest:     Thank you, Dr. Vliet... PFWLJ, go ahead.


PFWLJ:  What does the literature show of gain/re-arrangement of fat cells with HRT or is it just
the aging process?


Dr. Elizabeth Lee Vliet:   Actually less weight gain is found in women who are on hormone therapy with 
natural hormones than in women who do NOT take hormones after menopause.  We think this is due
to aging, inactivity, and the build up of the estrone form of  estrogen instead of the premenopausal 
balance with estradiol.  


Dearest:  Let me remind you all that if you're intested in reading Dr. Vliet's wonderful book, 
 "Screaming To Be Heard: Hormonal Connections Women Suspect...And Doctors Ignore" 
you can click this link and purchase it directly from Amazon.com.  


Dr. Elizabeth Lee Vliet:     Or you may call our 800# to order if you want an autographed copy!
800-509-1688.


Dearest:  Thank you.  BCOLL, go ahead.


BColl38000:     Is there a "natural estradiol" that comes in a supplement or cream like Progest?  
Should I ask my gyn or the health food store to figure doses? 


Dr. Elizabeth Lee Vliet:     Yes, you can get natural estradiol in cream form from compounding pharmacies - 
I use Spence Pharmacy 800-209-7364, Belmar 800-525-9473, and Madison 800-558-7046.   


CescaSF:        Should I stop using ProGest because it has affected my cycle?   It has helped alot to 
reduce severity of flashes and fog.


Dr. Elizabeth Lee Vliet:     Not necessarily stop it - but you should check your estradiol levels, and 
I would suggest balancing the progesterone with appropriate amounts of estradiol. I think you will find 
the brain fog helped even more.  


Dearest:    Dr. Diane Eisman asks, "There was an article in JAMA about ten years ago, saying Estriol
was breast protective.  Do you believe this is the case?  


Dr. Elizabeth Lee Vliet:     No, that article was only speculation, not actual research.  I address 
this issue in my book in detail in chapter 14 on the breast cancer issues.  It is important to look 
at all of these aspects. 


Dearest:         Thank you, Dr. V.... RCH, go ahead.


RCHCTH: What can be done for splitting finger nails?  (perimeno) Any suggestions?  


Dr. Elizabeth Lee Vliet:     Check your hormones, not only the ovary ones but also the thyroid, and 
levels of cortisol  and DHEA from the adrenal gland.   Healthy nails need healthy diet too!


ARC23:  My osteopenia was diagnosed 12/96 with a DEXA - 15% in spine, -25% in hip. I'm 50 and still 
having periods, but have now skipped the last 3 mo. Will see Dr.soon.  Should HRT be start started 
soon? Are the patches avail. in different strengths?  Would a cream be appropriate?  Or is oral the 
best route? Thanks  


Dr. Elizabeth Lee Vliet:  I think with this amount of bone loss it would be wise to consider starting 
the estradiol - patches come in several strengths, and either cream or oral could also work, depending 
on your preference.  The goal is to get blood levels about 100 pg/ml with whatever form you use. 
You can also use the new lower dose of Fosamax, which was recently approved by the FDA at 5 mg 
daily for prevention of bone loss.  


Dearest:  Excellent answers. Thank you! Susancee, please go ahead.


Susancee:   I made a consulatation appt armed with the info that you provided and I was given a Rx for 
Estrace and Comp. Micronized Progesterone.  I felt better in less than a week. Thank you for your help and 
helping me solve a problem that I struggled with for months!


Dr. Elizabeth Lee Vliet:   Glad my information helped you know what to ask for!  I am so glad to hear 
you felt better so quickly! -- This is why I LOVE what I do - it is sad to think that so many women have 
an opportunity to live so long, but don't feel OPTIMALLY well for the second half of our lives 
unless someone listens to what we need. 


Dearest:     Lizzie, go ahead :)


MsLizzieB:   Can wild yam cream (for flashes) cause heavy, more frequent periods? Am 53, in perimeno, 
and recently was told it did nothing and probably was not good cuz  of irregular doses.


Dr. Elizabeth Lee Vliet:  Yes, adding only progesterone as in the "wild yam" creams can definitely 
cause heavier bleeding IF the manufacturer has added progesterone to the cream - sometimes it is not 
shown on the label even though it is added to the cream labeled "wild yam."  Check Aeron Labs 
studies in Calif.  They have shown that the cream acts like progesterone, it is because USP
progesterone has been added to the product.  


Dearest:   Dr. Vliet, I have the Aeron information up on the Web site :) Thank you.
Wilds, go ahead.


WILDS52710:     I start period staining 23 day of cycle when i get my period the 27 to 29 day they
are shorter now.  does that mean my progestrone is lower?  I am 41 and trying to concieve and don't 
know if this is beginning of menopause.  what are chances of conception.  i am depressed a lot too


Dr. Elizabeth Lee Vliet:   It would be very valuable to have your hormone levels measured at specific 
cycle points.  It sounds like you may have difficulty conceiving unless you work with a specialist who 
can provide hormonal support to enhance your own. If still having periods, hormones should be checked
at cycle days 1-3, and ovul, and day 20 or so.  


BATCHIKA:       Can you recommend a clinic or Doc in California who approaches menopause treatment like 
you do?


Dr. Elizabeth Lee Vliet:  I have not found a suitable referral source in California to recommend.  Ones
I suggested in the past have not turned out to be philosophically compatible and women have written 
me with serious criticisms!! So I am still on the look-out. Don't want to suggest someone and have 
you be disappointed. 


Aquabebe2:      How many hours after the last oral dose of Estrace would you measure a blood level?  
And what is the "equivalent dose of Estrace to 0.9 of Premarin?


Dr. Elizabeth Lee Vliet:     Approximately 1.5 mg Estrace would equal 0.9 mg Premarin, but it is not an 
exact equivalent.  I go by levels, and how the person feels.  After taking Estrace, I suggest getting blood 
drawn the next AM if you took it at night.  If take in AM, then have done at end of day.  


Lacewing28:     I have Progesterine 25mg and Estriol 2mg.  Some pain in leg and breaking out, too much 
medication?  ApotheCure is where I get it from.  They say I should not have problems with natural hormone  
It is from soy based.


Dr. Elizabeth Lee Vliet:  Lacewing - Your regimen is unusal - I don't use anything like this.  Estriol 
doesn't provide the same effects at most receptors as we have with estradiol.  I would suggest getting 
some lab studies done.  The issue is not whether the hormones are natural, but whether the amount and 
type are right for what YOU need!!  


Lacewing28:   The doctor said at my age - 59 - there's no use to test hormones


Dr. Elizabeth Lee Vliet:     Lacewing - YOU ARE STILL YOUNG AT 59 -  Of course it is helpful to have 
the levels checked. Come see us in our Texas office!  


Lacewing28:     Thanks, I need blood work I am sure.



Z J Gragg:      If the patches are very good, why do the HMO's (FHP) consider them convinence dosing 
and not allowed?  Any suggestions for getting approval?  


Dr. Elizabeth Lee Vliet:     The patches are actually medically more sound - I don't view them as just 
convenience dosing.  I think HMO'S are just looking out for their own profits more than your health!  
Demand what you think you need for your best health!!  


GUENWYVAR:    Re Alzheimers & estradiol, does estradiol cause weight gain? I lost 18lbs after hysterectomy.
Some family members get diabetic if too fat.  My mom & her brother got Alzheimers from trauma. My dad's 
death & head injury; dad's 92 yr old brother has it now.  Should I ever take estradiol & if so, when? I 
am 51 now & herbs are doing fine. 


Dr. Elizabeth Lee Vliet:     Estradiol doesn't necessarily cause weight gain - have to watch the dose and 
route it is given.  It is usually the high levels of estrone and equilin estrogens and the synthetic 
progestins that cause most weight gain.  Just remember to check those bones!! 


Dearest:    Anyone interested in reading Dr. Vliet's fabulous, groundbreaking book, can click here to order 
"Screaming To BeHeard: Hormonal Connections Women Suspect ... And Doctors Ignore", at amazon.com. 
I highly recommend this book. 


WINDOCK1:       Does Zoloff have any affect on the thyroid?  (and thank you for being here tonight)


Dr. Elizabeth Lee Vliet:  You are welcome - I don't know of any interaction with the thyroid and I often 
see women on Zoloft.  


Dearest:    Dr. Vliet, can taking HRT reverse heart problems? 


Dr. Elizabeth Lee Vliet:  I have many patients in which that has been the result of good hormone 
therapy - but like a lot of things, it depends ont he the situation and how severe the heart disease is 
before treatment is started.  I see lots of women taper off blood pressure medicine when I get the hormones 
properly balanced.  


Dearest:    Also, something I've heard over the years about women who take HRT and smoke. What's the danger 
of smoking and using HRT? 


Dr. Elizabeth Lee Vliet:  Smoking itself causes direct vascular damage, and it also alters the metabolism
of the hormones by the liver.  It is not usually the hormones themselves - it is the serious 
complications on the body from smoking that is the culprit. 


Chloecake:  I have ovaries, but no uterus. Do I want progesterone?  Why cant I take it?


Dr. Elizabeth Lee Vliet:   Based on all the current research, you don't NEED progesterone if you don't 
have a uterus - but if it makes you FEEL better I don't know of any medical reason not to use it unless 
you are diabetic.  


Dearest:    Dr. Vliet,  we'd better move along, you have kept this room packed for a solid hour and a half!


Mylady99:   My GYN (female) never did hormone levels before putting me on them, Is that wise? 
Five years now.  I have all the bad side effects. How can I find an informed DR?


Dr. Elizabeth Lee Vliet:   I guess you have gathered I think it is important to check levels before and 
after starting hormones.  There isn't any other field of medicine where we give 85% of people the same 
drug and same dose and don't check levels before or after!  Never did make much sense to me!!  


PFWLJ:  Anything in the literature on HRT and women athletes or active, athletic women? 


Dr. Elizabeth Lee Vliet:  Yes, quite a bit.  You might check Med-line. 


ARC23:  I've read that Fosamax actually can leave bone more brittle after several years - comment? 
And do you believe Progest  taken alone protects bones?   Thanks.


Dr. Elizabeth Lee Vliet:  So far the studies have shown that Fosamax gives normal bone architecture 
and there have not been any reputable studies showing that Progest alone adequately preserves bone.  
You need the effects of estradiol, testosterone, calcium, magnesium ,vitamine D and elimination of 
dietary "bone-robbers'.  


Dearest:        How are you doing, Dr. V.?


Dr. Elizabeth Lee Vliet:     Yup - having a great time - some good questions tonight!  
 

Dearest:    I'm blown away by and in awe of your knowledge. 


Dr. Elizabeth Lee Vliet:   Thanks!  I have worked with all this for many years, and love my work!


Dearest:    Well, we love your work and you, too, and getting very straight answers!  Fran, go 
ahead, please. 


Fran Can 2:     Taking Prempro feel great - Is this okay or should I switch to "naturals"?  I am
59 years and postmeno for 9 years.


Dr. Elizabeth Lee Vliet: If you feel great, by all means stay with it. You might want to check levels, 
check your bone density and lipids to be sure you are getting all the benefits you expect.  
 

Dearest:    Dr. Vliet, someone just IM'ed me. She closed out of the chat. She asked if I'd ask you 
what dietary bone robbers are.  


Dr. Elizabeth Lee Vliet:   Bone robbers coming up: soda pop, alcohol, excess caffeine smoking, excessive 
amountsof protein (like Atkins diet), high phosphorus intake and inadequate magnesium - actually most 
American women have too little magnesium in their diets and should be taking supplements.  Also lack of 
calcium, and lack of exercise. 


Dearest:    What are some good food sources of magnesium? 


Dr. Elizabeth Lee Vliet:    Some odd sources -peanuts (unfortunately high in fat), egg yolks (ditto) 
but good news - acorn squash, almonds (high fat), black beans (good), figs - garbanzo beans -- sunflower 
seeds,  and of course that wonderful TOFU!  These are a few -- hope it helps.  


JewelCore:      Is it possible that lack of estrogen or imbalanace can cause chronic pelvic pain?


Dr. Elizabeth Lee Vliet:     Yes, definitely to Jewel.


Dearest:         What's the recommended dosage of magnesium per day?  I take 500 mg 3x a day.
 

Dr. Elizabeth Lee Vliet:     400-600 mg total daily dose is the recommended amount.  You can get TOO much
magnesium, so watch out.  


Calantmind:     I am 48, hysto. at 30 ovaries left.  How will I know when meno starts, or has it, low 
or no libido. Vaginal dryness -- would HRT help now?? Thanks


Dr. Elizabeth Lee Vliet:     You have a strong likelihood of already reaching endocrine meno levels 
since you had a hysterectomy at such a young age.  Your symptoms also suggest it so I think it would be 
wise to have a bone density, check your chol profile, and your hormone levels.  You may feel a lot better! 
  
Dearest:         Dr. Vliet, thank you for taking this time to join us in Power Surge to discuss your
fascinating theories and endless knowledge about "hormonal connections." What a stimulating discussion 
this was. We all hope you return to Power Surge very soon to share your infinite knowledge about those
things the women of Power Surge are "screaming" to be "heard."

Be sure to look for this wonderful book for women in menopause,  "Screaming To Be Heard: Hormonal 
Connections Women Suspect...And Doctors 
Ignore".


Dearest:         You can get an *autographed* copy of Dr. Vliet's book by calling 1-800-509-1688, OR 
directly from  Amazon.com  


Dr. Elizabeth Lee Vliet:     Thanks to all of you - you are great, and I love being here to 
try and answer your questions!  Hope it helps.  By the way, please don't count on me to answer 
e-mail - I travel too much, and forget to check it for weeks!  Don't take it personally - it has 
to do with my crazy life!


Dr. Elizabeth Lee Vliet:     Thanks, again, to all of you. It means a lot if the book has been 
helpful. I know how frustrating it can be. Goodnight, All. TAKE CHARGE OF YOUR HEALTH!


Dearest:  Thank you, again, Dr. Vliet. From reading it myself and sharing thoughts with other
women in Power Surge, your book is a big hit!


Read the transcript of Dr. Vliet's first visit
Read the transcript of Dr. Vliet's third visit


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