MENOPAUSE CHUCKLES

"Male menopause is a lot more fun than female menopause. With female menopause, we gain weight and get hot flashes. With male menopause, they get to date young girls and drive motorcycles." [Rita Rudner, comedian]

HEADLINES

Addendum: Please bear in mind that these facts about Premarin, Prempro and Premphase are provided by the manufacturer. Therefore, any risks involved with using HRT (hormone replacement therapy) is going to be minimized. Also, let us not forget the animal abuse allegations that continue to be cast at Wyeth Ayerst in the manufacture of the Premarin family of drugs. You can read about the animal abuse in other newsletters in the Reading Room .

FDA Clears One-Tablet PREMPRO(TM) and PREMPHASE(TM)

Hormone Replacement Therapies for Marketing

PHILADELPHIA, Nov. 20 /PRNewswire/ -- Wyeth-Ayerst Laboratories, a division of American Home Products Corporation (NYSE: AHP), received clearance from the U.S. Food and Drug Administration (FDA) to market one-tablet PREMPRO(TM) (conjugated estrogens/medroxyprogesterone acetate tablets) and PREMPHASE(TM) (conjugated estrogens/medroxyprogesterone acetate tablets). These are the first products to combine estrogen and progestin in one tablet. PREMPRO and PREMPHASE combine the estrogen in Premarin(R) (conjugated estrogens tablets, USP) with the progestin medroxyprogesterone acetate (MPA). Progestin is used in combination with estrogen to help protect the lining of the uterus.

"The combination of estrogen and progestin in one tablet marks a new milestone in hormone replacement therapy, also called HRT," said Marc Deitch, M.D., Vice President, Medical Affairs, and Medical Director, Wyeth-Ayerst Laboratories. "While women have been taking HRT for years, having estrogen and progestin available in one tablet for the first time is a dramatic advance in the way HRT is prescribed and taken. This advance comes at a time when interest in menopause is growing, as it is projected that more than 50 million American women will reach menopause by the year 2000."

One-tablet PREMPRO and PREMPHASE will mean new convenience for the approximately 4.6 million postmenopausal women who currently take estrogen and progestin. These one-tablet regimens are as effective as taking the two hormones separately, yet simpler and, in many cases, more economical. PREMPRO and PREMPHASE are the only one-tablet hormone replacement therapies indicated to help prevent osteoporosis in women at risk and to treat moderate to severe vasomotor symptoms (such as hot flashes and night sweats).

One-tablet PREMPRO and PREMPHASE combine progestin and the same estrogen as Premarin(R), the most widely studied estrogen replacement and the most prescribed medication in the United States today.

"Approximately one in four women over 50 are at risk for osteoporosis. For women at risk, prevention of postmenopausal osteoporosis through long-term HRT can be critical, because once bone is lost it cannot be replaced," said Lila E. Nachtigall, M.D., Professor of OB/GYN, New York University School of Medicine, and Director, Women's Wellness Center, NYU Medical Center. "For these women, either PREMPRO or PREMPHASE is generally recommended for an extended period of time to help prevent bone loss, while offering the additional benefit of convenience. Many of the women I treat have been asking for this logical next step in hormone replacement therapy, which will simplify the daily management of menopause."New Two-in-One Tablet Reduces Confusion, Simplifies HRT

Previously, physicians have prescribed estrogen and progestin for nonhysterectomized women needing HRT in a variety of different regimens. Until now, a woman taking estrogen and progestin at different times throughout the month had to keep track of where she was in her cycle and whether she needed to take one tablet (estrogen alone), or two tablets (estrogen and progestin) on any given day. As a result, many women found their HRT regimens difficult to follow. One-tablet hormone replacement therapy may provide an added compliance benefit.

"It is generally accepted that the fewer the tablets, the more likely a person is to take them as prescribed by their doctor," said Dr. Deitch. "Wyeth-Ayerst has packaged one-tablet PREMPRO and PREMPHASE in convenient calendar packs marked with the days of the week, making it much easier for women to take and keep track of the therapies prescribed by their doctor." PREMPRO and PREMPHASE may also be more economical as compared to two separate prescriptions.

• Contraindications

  Some women should not take HRT. A woman should make sure her doctor or health care provider is aware of her personal or family health history before taking HRT. This history should include instances of breast cancer, breast lumps, abnormal vaginal bleeding, abnormal blood clotting, severe headache, dizziness, and liver disease. Women who are pregnant should not take HRT. Estrogens have been reported to increase the risk of cancer of the uterus in postmenopausal women.

• Side Effects

  The most commonly reported side effects in the clinical study were breast tenderness, headache, and abdominal pain. Rarely, however, were these serious enough to cause women to stop therapy.

  Most studies have not shown a higher risk of breast cancer in women who have used estrogens. Some studies have reported that breast cancer developed more often in women who used estrogens for long periods of time or who used high doses for shorter time periods. The effects of added progestins on the risk of breast cancer are unknown. Some studies have reported a moderately increased risk in those taking combination estrogen/progestin therapy, even higher than the possible risk of taking estrogens alone. Other studies have not shown this relationship. The addition of progestin may have unfavorable effects on blood sugars and fats, which might make a diabetic condition worse.

American Home Products Corporation; Wyeth-Ayerst Laboratories

OVERHEARD ON THE NET

"Continuous combined HRT is usually daily Premarin 0.625 and medroxyprogesterone acetate 2.5 mg daily. This is the composition of Prempro. Some women with breast tenderness do better with combined estrogen/progestin 25 days of the month, or even 5 of 7 days. Sometimes tailoring the regimen helps, even though it sounds a little strange on the surface."

NOVEN PATCH SOLD IN 7 EUROPEAN COUNTRIES

Miami-based Noven Pharmaceuticals has launched sales of its flagship hormone replacement product in four more European countries. The estrogen replacement patch that treats postmenopausal symptoms is now being sold in Australia, Finland, France, the Netherlands, Spain, Sweden and the United Kingdom.

MENOPAUSE LIST F A Q

[Frequently Asked Questions]

• What are the symptoms of menopause?

  The symptoms of menopause are many, and varied! We're all different and our bodies react in different ways. The more common symptoms are: hot flashes, nite sweats, insomnia, depression, forgetfullness, mood swings, lighter periods, heavier periods, fatigue, shorter cycles, longer cycles, vaginal dryness, skipped heartbeats, digestive problems, palpitations, and more .

• What is the most common age for menopause?

  This is another area where there are no hard and fast 'rules', the national average for the American woman to cease having periods is 52.some women however, experience menopause in their 40'S or even 30'S.

• What is peri-menopause?

  Perimenopause is the term used for the stage leading up to menopause: hormone production is starting to fluctuate and you may be noticing hot flashes or other symptoms, but you are still having periods.

• Is there a test to determine whether or not you are in peri-menopause?

  Yes, the FSH blood test will determine whether or not your hormone levels were normal AT THE TIME THE BLOOD WAS DRAWN. The problem is, when perimenopause starts, the hormones may fluctuate wildly from one day to the next. If you have the blood test done on a day when the hormones are fairly normal, that doesn't neccesarily mean it was at a normal lever the day before or will be three days later! If you really need to know, having the test done 2 OR 3 times over a period of a few weeks is the most reliable method.

• How long does the transitional stage last ?

  Again, we're all different. Some women will breeze through it, one day they'll just realize they haven't had a period for a while. For others it may go on for as long as 10 years!

• What can I do to get through this transitional stage?

  There are many things you can try. Some women prefer to start taking HRT (hormone replacement therapy) right away, Others prefer to try and get through it without using drugs, others try 'natural' methods.

• What are some of the non-HRT methods?

  Taking vitamin E is said to help, but it must be natural vitamin E, not symthetic. You can tell by reading the ingredients on the label If it says 'acetate' it's synthetic. Others swear by the benefits of Ginseng, Dong Quai and other herbs, but the overwhelming choice of many is Mexican yam cream. Vitamin B6 is helpful as a natural diuretic. Three 100 mg. tablets per day is the recommended dose. All of these things can be found at your local health food store. There are several good books that can help you make good decisions about which herbs to use for which symptoms.

• What is this Mexican yam cream, also know as Natural Progesterone?

  The following information was provided by Denise Sobel, RN:

  "First, I highly recommend your reading Dr. John Lee's book, "Natural Progesterone." If you can't get it at your local bookstore, you can send $12.00 to:

• BLL Publishing P.O. Box 2068 Sebastopol, CA 95473 The cream is made from a wild mexican yam and it has been found to have the same chemical configuration as our own progesterone that we make only if we are still ovulating. Pharmaceutical companies will make other forms of progesterone to sell. They are unable to patent the natural progesterone. The synthetics are not of the same chemical congfiguration as the progesterone our ovary makes.

  Many have found some, if not almost 100% relief from perimenopausal symptoms using wild Mexican extract cream - natural Progesterone. It is an individual choice, and should be an informed one.

• Phillips Nutritionals sells Yamcon™. They can be reached at 800-514-5115, or you can write them at: 27071 Cabot Road, Suite 121, Laguna Hills, CA 92653. Currently, they're offering a jar of Yamcon Ceamfor $19.95 and if used as recommended, will last about two months. Most other companies sell their particular version for $32.50 and up. Yamcon also contains the highest concentrate of wild Mexican yam extract. I use both the cream and sublingual drops.]

• Professional and Technical in Oregon sells the cream: 1-800-866-9085.

• Gahler Industries, in Canada sells the cream: 1-800-663-8900.

• Women's International Pharmacy also sells the cream: Women's International Pharmacy 5708 Monona drive Madison, WI 53719- 3152 800 279 5708

  There are also other creams which are similar. A very good one is named Progestone-HP, made by Dixie Health Inc. and is carried by many health food stores. Cost is around $25..

• Are there side effects with Mexican yam cream (natural progesterone)?

  Yes, some women do experience side effects such as: diarrhea, irritability, night sweats, PMS-type mood changes, muscle and joint aches. For many these symptoms are gone by the 3rd or 4th month ofuse. Others just need to decrease the amount of cream used.

• How is the cream used?

  If you are not having periods, Dr. Lee suggests that you stop for 7 days. Here is one scenario given by P&T in their booklet:

• Day 1-7 do not use the cream Day 8-21 use 1/4 tsp twice a day Day 22-31 use 1/2 tsp twice a day

For vaginal dryness or discomfort use 1/4 to 1/2 tsp once a day intravaginally. This may be in addition to or instead of your daily applications.

You may use extra N.P. cream for immediate relief of symptoms. For hot flashes or night sweats, use 1/4 to 1/2 tsp every fifteen minutes for one hour following the episode.For persistent menopausal symptoms, N.P. oil may be used in addition to N.P. cream. For hot flashes or night sweats, hold 2-5 drops of the oil under the tongue for one hour following the episode. You may also rub the oil into the soles of the feet before bed. Some women find that they must use 1/2 tsp twice per day every day to get relief from menopausal symptoms. If you feel that skipping the first seven days would make you uncomfortable, you may use N.P. every day of the month.

If symptoms have not receded after a minimum of thre months of N.P. use, then a small amount of N. Estrogen for a limited time may be appropriate. This is all from the educational material provided by P&T. So, you see, it can be used to fit each individual person.

There are also other creams which are similar. A very good one is named Progestone-HP, made by Dixie Health Inc. and is carried by many health food stores. Currently a jar costs around $25.

MENOPAUSE READING

• Sheldon H. Cherry, MD; Carolyn Dl. Runowicz, MD - The Menopause Book 1994, Macmillan
• Janine O'Leary Cobb -- Understanding Menopause -- 1993
• Coney, S. (1994) -- The Menopause Industry: How The Medical Establishment Exploits Women. Alameda, CA: Hunter House.
• Colette Dowling -- You Mean I Don't *Have* to Feel This Way? -- (Bantam paperback, 1993).
• Linda Gannon -- The Potenital Role of Exercise in the Alleviation of Menstrual Disorders and Menopausal Symptoms.
• Gillian Ford -- What's Wrong With My Hormones - Desmond Ford Publications, 7955 Bullard Dr., Newcastle, CA 95658. This book is about both PMS and menopause. Hormone imbalance problems are related to both.
• Sadja Greenwood -- Menopause Naturally: Preparing for the Second Half of Life, 1989
• Germaine Greer -- The Change: Women, Aging and the Menopause
• A fabulous book, wide-ranging and angry and full of good ideas. Historical background as well as an up-to-date look at why we might be justified in becoming crones. Germaine Greer addresses the subject obliquely in her well-researched book, The Change: Women, Aging and the Menopause, which I recommend. It is more academic than some of the more popular books. She briefly cites Ann Mankowitz, in Change of Life, saying, 'Mankowitz finds evidence of the individual's celebration of a rite of passage in her Jungian analysis of her patient's dreams (see Chapter 12).' Chapter 12 is captioned 'Grief.' After reminding us of the five stages of grief, denial, anger, bargaining, depression, and acceptance, she goes on to say: "At menopause an old denied self reappears like a ghost, and may indeed reproach us for having delivered our lives over to the control of others who may now appear uncaring and unappreciative. The furious reproach, that one has given the best years of one's life or these or those is mostly self-reproach. The people we upbraid will tell us that they did not require or demand the sacrifice; at menopause we are charged by ourselves with having thrown the best years of our lives away. Images of waste, of squandering, and even of charade crowd our dreams waking and sleeping.'

  As the mother of a basketful of snakes, you might identify."- "It's informative, funny and full of good common sense regarding menopause and being an "older woman" in general. It made me feel exhilerated and happy to be 45 years old. Now that's a great accomplishment. If you haven't had the pleasure of reading it, do yourself a favor. I'm sure it will speak to you, as it did me. A well-written book against taking HRT, from a feminist viewpoint. She has some stuff in there about how women have been treated historically during menopause that will turn your hair more gray! . . . a real eye-opener albeit a bit shrill in parts. She even says that the reason women get irritable at age 50 is because it finally dawns on them that they have been treated badly all their lives and they begin to stand up for themselves and talk back!" [Reference:The Menopaus List]]

• Betty Kamen, Ph.D.: Hormone Replacement Therapy: Yes Or No? : How to make an informed decision about Estrogen, Progesterone, & other strategies for dealing with PMS, Menopause and Osteoporosis." I strongly recommend this book. If you can't locate it in your local library, or at your favorite bookstore, it's published by Nutrition Encounter, Box 5847, Novato, CA 94948; Tel. (415) 883-5154.

Having recently begun a regimen of natural progesterone via Mexican,wild yam, extract, using both the cream and sublingual forms, and having experienced some very positive results from same, I wanted to share this information on progesterone from Dr. Kamen's book.

EAVESDROPPING ON THE NET

"I had emergency surgery almost five years ago to remove a tortioned left ovary, and [snip]. So, there I was at 37 and --presto!!-- instant menopause. From all I've read, our experiences may be somewhat different from when nature takes its course."

Reply::

"There are several women who've had oophorectomies before age 40. Like you, I had one at 37. It was the worst thing that ever happened to me. As a result I have had severe problems with depression, memory, concentration, etc. Only within the last year (my surgery was 22 years ago) have I found a hormonal regimen that brings me back to a semblance of my pre-surgery self (and this regimen, using DHEA (one of the hormones produced by the ovaries and the adrenals), is very definitely not a standard one). There seems to be significant variation among women with the operation in the symptoms experienced and in the severity of the symptoms; one of the more frightening things is that my problems got significantly worse over the years. Medical research shows that, on the average, generally healthy women (women with prior medical or psychological problems were screened out of the study) had, as a result of oophorectomy, decreased mental energy, decreased feeling of well-being, decreased libido, and increased somatic symptoms (e.g., bone and joint pain). Other research shows a significant increase in depression symptoms among surgically menopausal women (and there is good reason to believe that this depression is physically caused, not a psychological reaction to the loss of fertility)."

MORE MENO NET TALK

"I was on Provera for four and a half years, finally developing all the side effects they could list in the drug books. I definitely had hypoglycemia; but the Provera was for an estrogenic fibroid tumor, and they also cause that locust-like feeling. However, Provera has been known to cause hunger and weight gain. The last year on progesterone, I switched to the natural progesterone they use in Europe, and which is now available in Canada. You can get in in suppository form, too; although I'm not sure that makes a difference in the blood levels of the stuff. That type is made from natural sources like yams, and tends to cause far fewer side effects. I lost most of my side effects when I changed to it, for sure! I do lots of aerobic exercise, so I didn't have to worry about weight gain; but I know that's a usual problem with Provera."