I remind you, once again, of a quote I picked up somewhere in my sojourns on the Net because it's simple, accurate and encouraging [we need all the encouragement we can get] .....

"Physically my body really seems to be falling apart.

I honestly don't feel well, but I don't have an illness

that can be cured - just a process to be endured."

There are those, too, who scoff at the notion of menopause as a "...process to be endured." They tell us, "You don't have to 'endure' anything. Take HRT to erradicate the symptoms of menopause." In many cases, they're correct. Yet, many can't, or simply don't want to take hormones. Further, it's important for them to know and accept the fact that it's really okay not to want to do hormones.

I've witnessed more than one woman being called to task regarding her preference not to do HRT. It reminds me of the visiting mother of my labor room companion [during the birth of my first child], who apprised me of the fact [after I'd been in labor at *least* 63 hours] that she'd given birth in only two.

This isn't to say that for many HRT isn't a viable option. It is not only viable, but an option many of us who can't take hormones, wish were open to us. If you're successfully managing HRT, and feeling great, more power to you. We all look forward to the day when synthetic estrogens and progesterones are counted among the safest of methods in coping with the myriad symptoms of menopause, which is why I try to continually provide as much info about HRT as I do the more natural methods.

The decision to forego HRT may be one of personal choice, wanting to go it 'au naturel'; one necessitated by medical circumstances which disallow HRT or, perhaps both! Many of us aren't satisfied with the lack of concrete evidence that HRT is a safe option. Many of us simply aren't comfortable with statistics regarding breast and ovarian cancer, to say nothing of the "iffy" communication between us, the *users*, and the medical profession and pharmaceutical companies. Even many with whom I've spoken who are going the HRT route are dubious.

The ultimate choice is, for many of us, "the lesser of two evils." Many are becoming leery of some of the natural treatments as well, such as herbs, what with indecision running rampant these days - one day something will save our lives - the next, kill us <sigh>. HRT users, and naturalists, alike, douse themselves with vitamin E, calcium, and spread wild Mexicanyam extract [natural progesterone] all over our breasts, bellies, arms, like icing on a cake. When noone's looking, we gleefully sway, sashay, and stomp our heels on our kitchen floors in a stance resemblant of a Flamenco dancer, our hands extended, snapping makeshift castanets [maybe cookie cutters], while singing the praises of Melatonin. Why? Because something seemingly 'natural' and 'harmless' provides us some modicum of comfort. Yes! Yes! ... a good night's sleep. We ask so little. We're so grateful when we happen upon something that *works* for us. On the other hand, we're now to be concerned about the longterm effects of Melatonin - a natural hormone produced by our brain's Pineal gland. As we age, the production of Melatonin decreases. Many of us find ourselves grasping at straws, feeling a sense of desperation for some sort of relief from the discomfort menopause seems to wreak upon our bodies and psyches. Is there nothing which makes us feel good that ultimately won't be bad for us, too?

I would once again remind you to OWN your bodies, OWN yourselves. These Power Surge newsletters are provided solely for the purpose of *sharing* information which will enable you to become aware of the many options available to you during this transitional time in your lives.

Read and understand! Weigh and measure your options!

Empower yourselves with knowledge to make educated decisions!

OWN your body!

Through this exploration and journey, and only by trial and error, will you effect the most positive results for yourselves. ASK QUESTIONS of your health care providers. Don't be afraid of appearing foolish. You probably know more about menopause than your physician ;D. If your doctor recommends HRT, and you don't want to take it, or there's no medical reason why you must take it, speak up. Medical decisions are still OURS, for the most part.

In the final analysis, menopause is a time wrought with confusion and, indecision - a journey of sorts. The famous author, doctor, philosopher, Deepok Choprah, tells us that life's journey is the destination, and seeking truth is an ongoing process. This journey through menopause isn't a test, it's an exploration. Menopause isn't a punishment - it's a natural, albeit very annoying, process which, despite our skepticism, *will* eventually end!

What to do in the interim? Read . . chat . . research. . but, most of all, SHARE the viable options available to us at this most challenging rite of passage, and . . . .

Dearest

A pleasant journey!

MENO BREAST HEALTH

All too often we ignore our breasts - find ourselves saying, "Oh, I'll have my breasts examined next time I go for a Pap smear." Riiiight? ...and how often do we put *off* going for that Pap smear? How many of us recoil at the thought of setting our legs up in those stirrups, in that most awkward position? How many of us *really* perform BSE [breast self-examination] on a regular basis? Uh huh.... do I see you nodding out there in agreement? Good. Let's talk about breasts! We're always to be concerned with breast health, but during and after menopause, breast health takes on even more importance.

Breast cancer is one of the leading causes of death for women. The average woman has one chance in nine (or about 11 percent) of developing breast cancer during her lifetime. It is the most common type of cancer among American women.

Each year, more than 175,000 women in the U.S. learn that they have breast cancer. Two-thirds of them will be over age 50. But breast cancer also occurs in younger women. And in men, too.

While breast cancer cannot currently be prevented, it can be treated, if detected early. Early detection is the key to survival. When it is detected early enough, it is often successfully treated; when it is not detected early, it is often fatal. For this reason breast examinations are of extreme importance to all women. Practicing breast exams helps increase your chances of detecting breast cancer in its earliest stages. Only about 20 percent of biopsied breast lumps are cancerous. And, if cancer is found early, there are choices for treatment.

With prompt, appropriate treatment, the outlook is good. In fact, most women treated for early breast cancer will be free from breast cancer for the rest of their lives.

The National Cancer Institute (NCI) suggests a three-point breast cancer detection plan. Mammography is the key to detecting breast cancer at its earliest stage because it can find a cancer up to two years before it can be felt.

Mammography screening for breast cancer offers no long-term survival benefit for women in their 40s, but that the test saves lives among women age 50 and older.

Currently, the American College of Physicians does not recommend mammograms for younger women.

NCI, however, currently recommends that women should start having this test at age 40. For women of all ages, other important exams include a breast examination by a doctor or other health professional and breast self-examination. These guidelines should be considered along with your background and medical history.

NCI currently recommends the following plan:

KNOW WHEN TO OBTAIN A MAMMOGRAM

Beginning at age 40, all women should be encouraged to have a mammogram every 1 to 2 years until age 50. After age 50, mammography should be done annually.

A mammogram is an x-ray of the breast. It can reveal tumors too small to be felt and can show other changes in the breast that may suggest cancer.

In mammography, the breast is pressed between two plates; some pressure is applied to get a clear picture. Usually, two x-rays are taken of each breast, one from the top and one from the side. Although some women are concerned about radiation exposure, the risk is very small.

Doctors recommend routine mammography because it is effective in finding breast cancer early. Long-term studies have shown that using mammography along with a breast exam by a health professional can reduce deaths from breast cancer among women.

These guidelines may change as new scientific information becomes available. The final decision, however, regarding mammograms, should be made on an individual basis.

A doctor also may suggest a mammogram if a symptom of breast cancer is found, whether through breast self exam (BSE), an examination by a physician, or by chance.

THE PHYSICAL BREAST EXAM

Both your gynecologist and your general health practitioner should perform regular breast exams on you, but it is even more important that you perform them regularly on yourself. It is important to begin a routine of self exams at an early age, because even though the incidence of breast cancer is extremely low in women in their teens and twenties compared to their thirties, forties, and fifties, it does occur. Also, it is necessary to be able to decipher what is normal breast tissue for you and what is not. Abnormal clumps or lumps of tissue are potential symptoms of problems and need to be detected and dealt with. It is these types of lumps that you are checking for while doing breast self exams.

Breast tissue is naturally lumpy, and it takes a little bit of time to become familiar with what is normal for you. The consistency of your breasts will often change throughout the menstrual cycle, and during/after menopause, becoming more lumpy just before menstruation, and unpredictable during/after menopause. Therefore the best time to examine your breasts is soon after you finish your period or, if no longer menstruating, at least on a monthly basis. It's wise to set up a schedule of breast self-exam once a month. You should examine your breasts at approximately the same time each month in order to monitor yourself effectively.

Women should have breast examinations by their physicians during routine checkups. Women age 40 and older should have them annually.

The next step in early detection is breast examination by a health professional. You may find it convenient to schedule this exam during your routine physical checkup. If a breast exam is not done during that checkup, ask for one.

Breasts come in all sizes and shapes, just as women do. Your own breasts will even change throughout your life. Your monthly menstrual cycle, menopause, childbirth, breast feeding, age, weight changes, birth control pills, and other hormones may change the shape, size and feel of your breasts.

It is important to learn what is normal for you. This can be done by doing breast self exams. It is easy to do, and as the name implies, you do it yourself.

REGULAR BREAST SELF-EXAMINATION

BSE [breat self-exam] is done once a month so that you become familiar with the usual appearance and feel of your own breasts. Familiarity makes it easier to notice any changes in your breasts from one month to another.

Some health professionals suggest that, at first, women do BSE every day for a month so that they really know the "geography" of their breasts. Early discovery of a change from what is normal is the whole idea behind BSE.

The best time to do BSE is 2 or 3 days after the end of your period, when your breasts are least likely to be tender or swollen. A woman who no longer has periods may find it helpful to pick a particular day, such as the first day of the month, to remind herself that it is time to do BSE.

If you discover anything unusual, such as a lump, a discharge from the nipple, or dimpling or puckering of the skin, you should see your doctor at once.

Recent research on the benefits of mammograms for women younger than age 50, however, is currently being analyzed by NCI and other health organizations.

If you have had a hysterectomy or no longer menstruate, examine your breasts on the first day of each month.

Follow this procedure:

During your shower, use the tips of the fingers of one hand as though you were tapping on your desk, and examine the opposite breast.

1. Look at your breasts in the mirror; look for puckering, swelling dimples, or scaling of the skin. Be sure your nipples move upward as the breasts do (that they don't seem "stuck" in place). Pressing your hands on your hips, bow slightly toward your mirror as you pull your shoulders and elbows forward. Again, check for any changes in the shape or contour of your breasts.

2. Watching closely in the mirror, clasp your hands behind your head and press your hands forward. Look for any changes in the shape or contour of your breasts.

4. Raise your left arm. Use three or four fingers of your right hand to explore your left breast firmly, carefully and thoroughly.

5. Beginning at the outer edge, press the flat part of your fingers in small circles, moving the circles slowly around the breast. Gradually work toward the nipple.

6. Be sure to cover the entire breast. Pay special attention to the area between the breast and the underarm, including the underarm itself. Feel for any unusual lump or mass under the skin.

7. Gently squeeze the nipple and look for a discharge. (If you have any discharge during the month -- whether or not it is during a breast self-examination -- see your doctor.) Repeat steps 4 and 5 on your right breast, using your left hand.

8. Lie down on your back on a firm surface. This position flattens the breast and makes it easier to examine. Use the same circular motion described earlier. Think of the breast as a pie made up of four sections, and examine each section carefully using the fingers of the opposite hand in a slow, circular motion. (Use the flat of the fingers rather than the fingertips). Put a small pillow or folded towel under the shoulder of the side you're examining. Using the opposite hand, press gently in small, circular motions over your entire breast and nipple. To make sure that you cover your whole breast, start at the top and go around it, like the face of a clock. Squeeze the nipple to see if there is any discharge. Change sides and repeat the exam on your right breast.

When examining your breasts in this manner, you want to use the flat of your fingers, not the tips, and feel around your breasts, one at a time, in a circular direction going from the outside (big circles) in (little circles). Monitor your breasts in this way for any abnormal lumps or tenderness. Sometimes it is helpful to raise your arm over your head on the side that is being examined, or to lie down to perform the exam.

You are looking for any mass, lump, or thickening under the skin. This step may be more effective for women with large breasts.

Breast self-examination is a valuable, preventive health practice for women. Developing a regular pattern will enhance your skills and help you notice changes. If you find a lump or changes in your breast, contact your health care provider.

Women, during menopause, are even more vulnerable - especially those taking hormones... and should give extra attention to their breasts. Become familiar with your breasts - their shape and texture. OWN your breasts as part of the body you OWN.

Many women have irregular or "lumpy" breasts. The term "benign breast condition" refers to those changes in a woman's breasts that are not cancerous. Many doctors believe that nearly all women have some benign breast changes after age 30. But any change is best diagnosed by your doctor.

Other Methods Used For Early Detection

Currently, manual breast exams and mammography are the most common and useful techniques for finding breast cancer. However, several other methods are also being used.

Ultrasound detects breast changes by sending high-frequency sound waves into the breast. The pattern of echoes from these sound waves is converted into an image of the breast's interior.

Ultrasound may be helpful in distinguishing between solid masses and cysts (fluid-filled sacs). Unlike mammography, ultrasound cannot detect small calcium deposits that may be present in the breast and that sometimes indicate cancer, nor does it identify small tumors.

Thermography measures heat patterns given off by the skin. Changes in the image, including "hot spots," may suggest the presence of a breast problem. There is no known risk of using thermography, but it is not reliable enough to replace mammography.

Diaphanography, or transillumination, shines a bright light through the breast. Transillumination can show the difference between a solid tumor and a cyst. Current studies indicate that this method does not identify the very small cancers that can be detected by mammography.

Reference:

U.S. Dapartment of Health & Human Services, National Cancer Institute
Denton, S., & Miller, K.A. (1982). Breast cancer. In R.A. McNeeley (Ed.),
CounSELFile: A self-health management guide. Tucson, AZ: W.K. Kellogg
Foundation and the University of Arizona.

Fibrocystic Breasts

Think of the breast as a pie made up of four sections, and examine each section carefully using the fingers of the opposite hand in a slow, circular motion. (Use the flat of the fingers rather than the fingertips.) In addition to feeling for lumps, you should stand in front of a mirror and look for changes in the contour or appearance of each breast. If you do find a lump or notice any change in the appearance of one or both breasts, you should make an appointment to have your breasts examined by a clinician.

Most breast lumps are discovered by women, themselves, incidentall or during the BSE. The most common cause of lumps in women in the childbearing age (18 to 45 years) is referred to as FIBROCYSTIC BREAST DISEASE. Other names that have been used to describe this problem are "mammary dysplasia," "chronic cystic mastitis," and "benign breast disease."The term fibrocystic breast disease actually covers a broad range of conditions from painful breasts with solid lumpy patches to cysts (lumps filled with fluid). A woman with this disorder may have several onpainful lumps in one or both breast(s) and/or the breast(s) may feel painful, dull, and full. When examined with the fingers, the lumps are usually tender, firm, and slightly movable. Rarely, a clear or pink watery fluid may drain from the nipple. Often, a trained examiner (physician or nurse practitioner) can distinguish between the changes that are suggestive of malignancy or those of a nonmalignant breast disorder. There are also several procedures which are helpful in the differentiation of breast lumps: mammography, an x-ray of the breast; ultrasound, which uses sound waves to make a picture of the structures inside the breast; and needle aspiration, in which a fine needle is inserted into the lump and any fluid present is withdrawn and analyzed.

Although all women should perform the BSE regularly, you should be especially diligent if you have been diagnosed as having fibrocystic breast disease or if you are in the high risk group for breast disorders. High risk is defined as those women who have a family history of breast cancer or benign breast disease, particularly a mother or a sister. It also includes women who have had no children, who are Jewish, white, who have severe premenstrual syndrome or menstrual irregularities. There is some speculation at this time that smoking, a high fat diet, and alcohol consumption (greater than 3 drinks per week) may be associated with a higher risk of breast disease.

Fortunately, many times fibrocystic breast disease can be easily managed, depending on the character of the lumps, the amount of discomfort, and the family history. Conservative measures include wearing a well-fitting supportive bra and loose-fitting clothing. Ice packs or warm compresses applied to the tender areas may give relief. The elimination or substantial reduction from the diet of caffeine (found in coffee, tea, cola drinks, and chocolate) for several months has resulted in diminished symptoms for up to 80% of the women studied. Reducing the amount of fluid your body retains before your period can also ease discomfort. This can be done by reducing the intake of salty food, especially the week before your period. A few studies have suggested that a daily supplement of vitamin E (600 IU or one tablet) and a B multivitamin preparation may also alleviate symptoms. Other generally healthful measures in this regard include reducing the amount of fat in the diet, drinking less alcohol, and no smoking.

For very severe cases your physician may prescribe hormones such as progesterone, oral contraceptives, or the drug danazol. Rarely, surgery is performed if the lumps are very large or troublesome, or if the family history is positive for malignant disease, as women with some specific types of fibrocystic breast disease are thought by some experts to be more likely to develop breast cancer. However, there remains a good deal of controversy on the connection between fibrocystic disease and breast cancer.

If you are concerned about any difference in your treatment plan and the information in this handout, you are advised to contact your health care provider.