Hormones- Should We Take Them or Not?

Hormone replacement therapy (HRT) for menopausal women has been back in the news. In medicine, we've swung from placing virtually every post-menopausal woman on estrogen to barely allowing even the most miserable, hot-flashing, night-sweating woman to have any (after the Women's Health Initiative- WHI). What's the answer? Is estrogen safe or not?

As always, the devil is in the details. The WHI never said that we shouldn't be using estrogen (and progesterone) for women who had menopausal symptoms (such as hot flashes and night sweats). In fact, this is an excellent use of estrogen, and physicians and patients need not fear the short term (around five years) use of hormones to reduce symptoms as a woman's body adjusts to menopause.

The larger questions are those involving taking hormones as prevention for other issues, such as thinning bones (osteoporosis), heart disease, or dementia. Although earlier studies suggested estrogen helped protect against Alzheimers, there is not enough evidence to support taking HRT for this reason. Estrogen is one of the strongest protective factors for thinning bones, however, so for women at high risk for osteoporosis and bone fracture, there is data to support starting hormones around menopause in this group. Heart disease, however, is another story. The old thinking was that it was estrogen in women that allowed women to have lower rates of heart attacks than men, and therefore HRT might continue that benefit for menopausal women. The WHI study raised the alarm that women on HRT had a higher incidence of cardiovascular events (heart attack and stroke), and therefore confirmed other studies that suggested HRT is not appropriate if given only for prevention of heart disease. This was not new information, but it was magnified in the media and popular interpretation was that HRT is BAD and causes heart disease.

What do we know today? We shouldn't be starting hormone therapy on women who have gone through menopause many years ago. Hormone therapy is best used at the beginning of menopause, and is fully indicated for those women who are complaining of hot flashes, insomnia, night sweats, etc., during this transition time. How long should we use it? About five years. If symptoms flare as the woman tries to go off HRT, go back on for awhile longer and try to taper next year. There are many subtleties that need to be addressed (such as adding progesterone if the woman still has a uterus) but the take home message should be that women need not suffer through menopausal symptoms.

BOTTOM LINE: Estrogen is still the best medication to address menopausal symptoms such as hot flashes, insomnia, and night sweats- talk to your doctor about HRT if you are suffering!

Let's GO! Rap with tha Hip Hop Doc & Get Healthy!

Last week I was blogging on heart disease in women, and the American Heart Association's new guidelines calling awareness to the NUMBER ONE KILLER of women here in the United States. Today, I'm excited to bring you a HEART-PUMPING song that will stick in your brain and keep you moving and dancing all day!

Meet the Hip Hop Doc- Dr. Rani Whitfield- a very cool FAMILY PHYSICIAN who has found a unique way to reach his patients. His Youtube video "Let's Go!" speaks directly to us women, telling us to "Wait-FREEZE- Don't eat that! Fatty foods cause heart attacks!" (Click on LET"S GO to see the video!)I love it! Our whole house is now dancing and singing these words as we open the fridge and scout around.

Dr. Whitfield didn't stop with just the video, though. Check out his website, www.h2doc and you'll be amazed with all his efforts. From his six month campaign of heart runs and walks to raise awareness about heart disease, to his innovative new comic book and the Legion of Health- super-sized super heroes with names like Suga Free, Six Pack, and of course, h2d (that's Hip Hop Doc, if you're not following closely...)- his message engages everyone, with a special appeal to youth and those young at heart.

BOTTOM LINE: Check out tha Hip Hop Doc, and come on everyone, Let's GO!

Yea! Chocolate is still "Good for you"!

Ah, there must be women out there doing research (or at least men who love us), because we continue to see attempts to prove that chocolate is good for us! There is now another study that shows "moderate" consumption of chocolate- 1-2 servings per week- reduces your risk of heart failure.

Now, listen closely- I did NOT say that eating an extra large Snickers bar every day will enhance your heart health- sorry! The study, entitled " Study of Middle-Aged and Elderly Women Chocolate Intake and Incidence of Heart Failure: A Population-Based, Prospective " analyzed the incidence of heart failure in over 30,000 women aged 48 to 83 compared to their average intake of chocolate. The study took place in Sweden, where their delicious dark chocolate must contain at least 35% cocoa solids (vs. 15% in the USA).

We know that dark chocolate consumption in moderate amounts has been shown to lower both systolic and diastolic blood pressure. This study suggests that the benefits extend beyond blood pressure and on to consequences of high blood pressure, such as heart failure.

BOTTOM LINE: I am happy to report that there is continued evidence that having a few servings (ounces) of dark chocolate each week may not only please your tastebuds, but perhaps also your heart! Dip a luscious strawberry into some melted dark European chocolate and ENJOY!!

Just for the Women- Period.

Okay, today I want to talk about periods- menstruation- so this is for the women. Periods, like bowel movement patterns, are unique to each individual. In the textbooks, periods occur every 28 days, and last for a week. In reality, there is more variation. When an adolescent starts having periods, they are often very unpredictable for the first six months to a year. At that point, most young women establish a pattern that they can recognize and therefore predict when their next period should arrive. Some may be as short as 21 days, others beyond 30, but what is important is recognizing what your pattern is. Consider the modern calendar- a period tracker app- for your phone to figure out your cycle.

Are terrible cramps okay? Well, no- absolutely not! First of all, we have several medicines that might help, from ibuprofen and its cousins to using the contraceptive pill to help decrease the amount of cramping and blood loss. Additionally, for women who have pain outside the range of "normal", we begin to be concerned about endometriosis, a condition where extra tissue that belongs inside the uterus may have migrated outside of the uterus into the pelvis, and be stuck on the intestines or fallopian tubes, causing pain especially at ovulation (mid-cycle.)

Please do not suffer in silence! If you have "terrible periods" that make you miss school, work or fun stuff, make an appointment with your doctor! There are many ways your doctor can minimize your pain and help your life to NOT revolve around your menstrual cycle. Additionally, if it's PMS symptoms that drive you nuts (bloating, headaches, mood swings, and breast tenderness), there are simple behavioral modifications like quitting caffeine, increasing your calcium intake and increasing aerobic exercise that will help.

BOTTOM LINE: TALK to your doctor if you have questions about your period, and know we have many more answers beyond Midol or "the Pill".