Results from a recent study support the idea that if hormone replacement therapy is given near the time that a woman enters menopause, that there is NOT an increase risk of cardiovascular risk. This data should reassure women that low dose, preferably trans-dermal menopausal hormone therapy is safe, effective and can help improve symptoms. Menopausal hormone therapy needs to individualized for each patient after a review of the patient's medical and family history, current health status and menopause symptoms. There is no one "correct" way to treat menopausal symptoms and I encourage women to consider their full range of options, from lifestyle and diet, over the counter supplements , to hormone replacement. There are many great options, and the bottom line is that you should not suffer with menopausal symptoms.
From the KEEP study-
KEEPS hormone therapy trial in newly menopausal women (September 2014)
The Women's Health Initiative (WHI), a set of menopausal hormone therapy (MHT) trials in older postmenopausal women (average age 63 years) reported an excess risk of coronary heart disease (CHD) with MHT. Emerging data, including secondary analyses from the WHI, now suggest that use of MHT in the early menopausal years is not associated with excess CHD risk. The Kronos Early Estrogen Prevention Study (KEEPS) is the first randomized trial of MHT in younger menopausal women (727 women ages 45 to 54 years) . When combined with cyclical monthly oral progesterone, low dose oral conjugated estrogen (0.45 mg daily) or transdermal estradiol (50 mcg daily) for four years relieved menopausal symptoms. While several markers of cardiovascular risk improved in the MHT group, there was no significant effect on surrogate markers of atherosclerosis progression (coronary artery calcium and carotid intima-medial thickness) when compared to placebo. This trial provides additional reassurance that early use of MHT is safe for the treatment of menopausal symptoms, though it does not support a role for MHT in prevention.
It was a great day yesterday at the first ever Young Survivors Conference hosted by Breast Cancer Options and the Young Survival Coalition. I was honored to be a speaker. For those of you interested, please see a copy of my presentation below. I will post the video of the conference and the other speakers's presentations when they become available. Thank you Hope Nemiroff Breast Cancer Options for putting this together! For more information check out www.breastcanceroptions.org and www.youngsurvival.org
Please spread the word on this excellent free conference that I will be speaking at next weekend.
I will be doing a Women's Wellness presentation with two fantastic female health care colleagues on the topic of managing Peri-Menopause on Dec. 5th at 7 pm at the Pleasantville Library. Stephanie Schwartz, RD,MS,CDN, of Nutritionally Yours, has a wealth of experience in menopause, women's health and cancer prevention. Susan Riordan, MSPT, ATC is women's health physical therapist with expertise in dealing with pelvic floor dysfunction, urinary incontinence and other issues pertinent to women transitioning to menopause. This will be an informal talk open to all women in their late interested in learning about peri- menopause. Topics covered will be hormone changes, the stress-hormone connection, managing menstrual dysfunction and symptoms, overview of traditional and alternative therapies for menopause, including nutrition, exercise and stress management. Email firstname.lastname@example.org to RSVP or for more information. See flyer below !
good article in the NY Times about fertility after a cancer diagnosis.
Here is a funny and well done video about a girl's first period. It was done by Hello Flo, a period supply delivery service. Who knew you could get "period care packages"? They even have a starter kit- with candy in all! We all know how much we crave chocolate at that time of month! This service packs the pads, tampons and chocolate fix in one perfectly timed box. Not sure how necessary this is, but the video sure is funny!http://youtu.be/0XnzfRqkRxU
Treating the whole patient should always be our focus as physicians. Unfortunately for many women facing cancer, quality of life issues are often ignored. Check out this great article by a young cancer survivor on how she has coped with the often unspoken side effects of cancer treatments- including early menopause and sexual dysfunction. I hope to address these overlooked issues in my practice with my patients.
A post from Life Interrupted in the NYT
Thanks to the recommendation of my good friend, I just read this excellent article on Breast Cancer in the NY Times. Written from the perspective of a fellow survivor, it raises thought provoking questions about our society's approach to screening, treatment and research. Unfortunately, it doesn't provide any easy answers and leaves the reader unsettled and a bit confused. But that is OK, because there are not easy answers when it come to breast cancer. And patients are not statistics or numbers in a public health study.Most striking was the discussion on metastatic disease and the fact that not every one is a "survivor", and our mothers and sisters who are struggling with metastatic disease are the often hidden by the "pink" movement. The "pink washing" and over-commercialization of breast cancer for profit by corporations add to the confusion. Bottom line is that women must be their own health care advocates and they must be able to think critically about their health care options. You cannot stand on the sideline and be passive. If something doesn't sit right with you- question it. The same goes for your body. If it doesn't feel right, act. If you are not getting answers , keep asking. Find a doctor who will listen and partner with you. Check out the article here:
Our Feel Good War on Breast Cancer
Many parents wonder when to address their daughters’ gynecologic health issues. Adolescent girls are confronted with numerous challenges, and the decisions they make can have serious consequences for their health and well-being. To this end, it is recommend that girls first visit a gynecologist between the ages of 13 years and 15 years or sooner if you have concerns.
The following three suggestions are ways we can work together to guide your daughter to a lifetime of good health.
1) Get informed. Ask us for handouts and resources that deal with teen issues. We have or can find materials on health topics that you can use in talks with your daughter. This includes reproductive health topics, such as menstruation (eg, what to expect, menstrual cramps or irregularity, tampon use, and hygiene), promoting abstinence, and contraception. We also can help you to learn about other health issues, such as alcohol and tobacco use, safe driving, and healthy diet and exercise.
2) Talk with your daughter. Many health topics warrant open discussion. For example, although it may be awkward to discuss sex, it is important to talk with your daughter about it. In fact, parents who do so are more likely to have daughters who delay having sex. Too often, school health education programs lack important information. Thus, it is important for parents and physicians to work together with teens to fill in any gaps. A great resource is a book I recently read, called "Talk to Me First" by Deborah Roffman. It focuses on how to make discussing sex and sexual health a natural part of your relationship with your children and not a taboo.
3) Be sure your daughter is seeing a health care practitioner who will discuss preventive health care issues with her, including pregnancy, prevention of sexually transmitted diseases, and immunizations. By bringing your daughter in at this age, we can work with you to give her the knowledge and skills she needs to make healthy decisions, identify important behavioral or physical health issues, provide any needed treatment, and refer her for other services, if needed. Understand the importance of this confidential relationship and know that I will always work to encourage communication between a teen and her parents.
4) Some girls are initially reluctant to visit a gynecologist because they do not want a pelvic examination. However, in most cases, a pelvic examination is not needed for young teens.
Ask us if you have any questions about adolescent health. Together, we can work to keep your daughter healthy and safe.
After working hard the last few months, I am excited to announce that I will be accepting new patients in April. Please call for more information and an appointment.