POWER SURGE NEWS
FOR AOL AND THE WEB
A Free E-Mail Newsletter
of the Power Surge Women's
Midlife and Menopause Community
The Power Surge Web Site
Dearest (Alice Stamm)
Founder and Facilitator

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POWER SURGE NEWS
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Surgettes,

Never, for one moment, entertain the false notion that talking, sharing, and expressing your concerns and fears about menopause is indicative of the fact that you're not trendy, politically correct, savvy, a 'woman of the 90's', etc. Any woman in emotional or physical discomfort should express her feelings, lest she relegate herself back to the dark ages.

There are a whole host of dynamics that go into this process called menopause. It's not simply that we're losing our periods. It's not simply a matter of soon being unable to conceive, bear chillenz, reproduce the spe-sheeze, geeze, Louise. It's not simply a matter of coming to grips with the realities of 'aging', nor whether or not to take hormones, nor being ashamed of the desire to do menopause au naturel, if we so choose, or if the option to do HRT [hormone replacement therapy] isn't ours due to medical reasons, familial issues such as cancer, osteo, etc. It's not simply concerns about feeling less dainty, less feminine, less desirable, less of a WOMAN!

It's ALL of the above!

As Woody Allen coined it . . ."heavy-osity" -- those are heavy-osity dynamics, no?

A few years back I read a quote by a renowned feminist regarding menopause. My intention is not to diss feminism here. The gist of it was similar to that of, "Real Men Don't Eat Quiche." Her attitude was that real women of the 90's -- the movers, the shakers, the upwardly mobile, don't suffer from menopausal symptoms. Balderdash! Menopause is not a political issue. Neither is menopause a feminist issue. One isn't spared the difficulties endemic to menopause because of her political affiliation. Its concerns are with the physical, psychological and spiritual feelings involved with the process, and NOT any political agenda. I take exception to any remark which alludes, implies, or otherwise denies that women experience a whole plethora of difficulties during the pause, and IT'S OKAY to feel them, and talk about them, and reach out for support from others who are feeling them, too. It doesn't make you less of a person!

By discussing, asking, sharing and networking, you're expanding your knowledge. Discussing turns over ideas, shares concepts and possibilities. Talking is part of what our generation is all about. What on earth is more PC [politically correct] than that? Beats me!

So, if you've ever found yourself in a situation where others make you feel less than . . . ugh . . politically correct . . because you're not coping all that well, or you don't want to don the costume of a martyr, or you're frustrated and depressed by the process, and sick and tired, and sometimes embarrassed [yes, that's okay, too] by hot flashes, night sweats etc., etc., hold your head up high and remind them that in order to lighten the load of this time of your life, you may be hot flashing and palpitating, waking up with the sweats, crying with no provocation . . .

BUT that you're becoming enlightened by surfing the net with a group of very savvy women - sojourning along the super information highway - learning and sharing, and becoming enriched and enlightened via bytes, bells and whistles ...

Now, WHAT could possibly be more politically correct than that?

Strength comes from support.

Sharing and Support provide knowledge, not Crutches.

. . . And we know what knowledge yields .

Dearest

1. Meno Reading
2. A Very Real Osteo Story
3. Charlotte Libov And Heart Enlightenment
4. New Heart Benefits Of Estrogen Replacement Therapy
5. Paxil: Cleared By FDA
6. Reliance For Stress Incontinence
7. Thoughts From Some Of Power Surge's Experts
8. Risks/Benefits of Hormone Replacement Therapy
9. Menopause Society Communications
10. Hysterectomy Educational Resources/Services Foundation - HERS
11. Books: Personal Growth
12. Books: Depression
13. Books: Weight Issues
14. Books: Relationships
15. Books: Miscellaneous
16. Books: Humor
17. Power Surge Happenings

MEN_O_PAUSING

When a woman reaches menopause, she goes through a variety of complicated emotional, psychological, and biological changes. The nature and degree of the changes varies with the individual.

Menopause in a man provokes a uniform reaction. He buys aviator glasses, a snazzy French cap and leather driving gloves, and goes shopping for an expensive foreign sports car.

NEW AND EXCELLENT MENO READING

• Women, Men, and Testosterone - by Kathryn Grosz
  MA Published March/1995
  by Freedom Enterprises
  PO Box 5001
  Ben Lomond, CA 95005
  Good monograph/pamphlet and bibliography.

• The Hormone Of Desire: The Truth About Sexuality, Menopause and Testosterone" by Susan Rako, M.D.

  "Menopause is a journey through poorly charted waters. And most physicians approach the possibility of prescribing supplementary testosterone for women suffering symptoms of its deficiency with the resistance and ignorance of sailors who believed the earth was flat, and that if they proceeded to sail on, they would fall off." Susan Rako, M.D.
  

  From the introduction by Barbara Bartlik, M.D., and Helen Singer Kaplan, M.D., Ph.D. - "Today women of all ages have come to appreciate their potential for a fulfilling and enduring sexual life. Dr. Susan Rako has researched and written a landmark book - Gracefully, intelligently, and sensitively written, The Hormone of Desire began as Dr. Rako's own story, a story of challenge, inspiration and determination..."

• The Menopause Self Help Book -- Susan M. Lark, M.D. PMS Self Help Book - By: Susan M. Lark, M.D.

A VERY REAL OSTEOPOROSIS STORY

Helen, age 68, awoke out of a sound sleep one night. When she sat up in bed, she heard "a crunching noise and felt a sharp pain in her back." A few days later, she visited a bone specialist who explained that the noise she heard was the collapse of several vertebrae in her spine.

Helen was diagnosed as having osteoporosis, a thinning of the bones which makes them weaker and allows them to break more easily. Helen's condition as described in Dr. Morris Notelovitz's book, "Menopause and Midlife Health," affects approximately one in four postmenopausal women. Osteoporosis is often called a "silent disease" because it develops without symptoms.

Everyone loses some bone mass (bone thickness) after age 40. But menopausal women lose bone mass faster than premenopausal women. Estrogen deficiency is responsible for at least 75 percent of the bone lost in the first 20 years after menopause. This accelerated loss can lead to osteoporosis. The bones of the spine, wrist and hips are affected most often. In general, the risk of hip fractures increases as you get older.

Women who are likely to develop osteoporosis often have the following characteristics:

• White or Asian race
• Slim build
• Cigarette smokers
• Family history of osteoporosis in a mother, sister or aunt
• Early menopause, often because their ovaries were removed during an operation (surgical menopause)

There is no cure for osteoporosis, but there are measures to help prevent it. A diet high in calcium and a regular program of weight-bearing exercise (such as walking or running for an hour, two or three times a week) can slow down or prevent further bone loss. Health care providers have recognized that estrogen plays an important role in helping to prevent osteoporosis. Therefore, in addition to a high-calcium diet and regular exercise, your health care provider may prescribe estrogen replacement therapy (ERT) for you. ERT cannot restore bone that is already lost, but it can protect against further bone loss and reduce the risk of osteoporosis-related fractures.

Estrogen therapy has reduced the incidence of hip and wrist fracture by 60 percent in some medical studies. One estrogen replacement therapy prescribed by health care providers for the prevention of osteoporosis is ESTRACE(R) (estradiol tablets, USP) tablets 0.5 mg, made by Bristol-Myers Squibb Company. The active ingredient in ESTRACE is 17-beta estradiol, which is made from natural plant sources and resembles a woman's estrogen. ESTRACE allows you to supplement the estrogen your body begins to lose at menopause. ERT is not for every woman. Discuss with your health care provider whether it's right for you. There are possible side effects with estrogen. One is an increased risk of cancer of the uterus. Estrogens should not be used during pregnancy. Estrogens should not be used if you've had abnormal vaginal bleeding or abnormal blood clotting. Advise your health care provider if you've had heart disease or cancer of the breast or uterus.

Osteoporosis contributes to more than a million fractures a year and costs the health care system about $10 billion annually. A woman can expect to live as much as a third of her life after menopause, and women today want to live it in good health. Osteoporosis can be a serious condition if not prevented.

For more information on osteoporosis, call the National Menopause Foundation, Inc. at 1-800-MENOASK. Bristol-Myers Squibb is a diversified, research-based health and personal care company whose principal businesses are pharmaceuticals, consumer products, nutritionals and medical devices. The Company is among the world's leading makers of cardiovascular, anticancer, anti-infective, central nervous system and dermatological therapies and non-prescription medicines.

CHARLOTTE LIBOV Of The Web's 'Women's Health Line'

Enlightening Us About Women And Heart Disease

Charlotte Libov has been a guest in Power Surge, and is a professional speaker, advocate and award-winning author on women's health issues. She was a veteran reporter and freelance writer when, at the age of 40, she learned she had to undergo open-heart surgery. Unable to find resources focusing on women and heart problems, Ms. Libov teamed up with a cardiologist to co-author, The Women's Heart Book: The Complete Guide To Keeping Your Heart Healthy and What To Do If Things Go Wrong." They've also written 50 Essential Things To Do When The Doctor Says It's Heart Disease, published by Plume. Ms. Libov also helped create and is featured in Women's Hearts At Risk, a one hour documentary broadcast by PBS this past year. She is also the founder of National Women's Heart Health Day (Feb. 1), serves on "The Difference In A Woman's Heart" medical advisory board, a national public awareness campaign supported by the American Heart Association and the American Medical Women's Association. She is the founder and editor of Women's Health Hot Line. Click here to visit Charlotte Libov's Web site Women's Health Hot Line

A few words from Charlotte about Power Surge :). "I'm delighted to participate in Power Surge. Thanks to Dearest, there are always informative articles on hand and knowledgable guests on board, but to me, most important feature is that Power Surge provides women with a safe place to share their feelings and fosters sisterhood in the deepest, most positive sense."

Here, now, two excellent, informative and insightful articles written by Charlotte Libov.

CONGRESS CONSIDERS FUNDING TO FIGHT HEART DISEASE IN WOMEN

By Charlotte Libov

Efforts to raise awareness of heart disease in women got an important boost when a landmark bill targeting $140 million for the cause was submitted to Congress. The bill, which may be the first in its kind, calls for expanded efforts to help fight heart disease, the Number One killer of American women.

"Cardiovascular diseases have claimed the lives of more females than ALL forms of cancer combined, yet research funding for heart disease is scarce," said Congresswoman Maxine Waters, a Californian Democrat who submitted the bill. \ In submitting the bill, Waters noted that nearly a half-million American women die from cardiovascular diseases each year, which is almost double the number that die of all forms of cancer and five times as many that breast cancer kills.

"For many years, women and minorities have been underrepresented in heart and stroke research. Tests for detection and equipment to treat these diseases are largely based on studies of men; not all collected data is applicable to women. Better tests and equipment are needed to diagnose the disease," she said.

Furthermore, the bill would provide funding to establish educational outreach programs for omen and their doctors about how to prevent cardiovascular disease. "This bill could help us try to save or extend the lives of thousands of our mothers, grandmothers, sisters, aunts and daughters," she said. Waters also noted that heart disease in women is of major concern to the minority community. She noted that African-American women are the most likely to die after suffering a heart attack, and are twice as likely to die between the ages of 35 and 74 than white female heart attack victims are.

The first hurdle for the bill is to win approval from the U.S. House of Representatives Subcommittee on Health and Environment, which is part of the Commerce Committee. Given the Republican composition of Congress, and the cost-cutting environment, the bill faces an uphill battle. Still, simply the submission of the bill represents a giant step forward in focusing public attention on this important issue. The bill is part of a package of measures known as the Women's Health Equity Act of 1996. The package of bills seeks to improve research and health care services for American women. When Waters first reviewed the package of bills, none addressed the issue of heart disease in women. The very lack of bills on this important measure further underscored how sorely heart disease in women is overlooked and motivated Waters to submit the bill.

EDITORIAL: RHODA DAUM DIED TOO YOUNG

By Charlotte Libov

Recently, I was interviewed by Connecticut radio host, Rhoda Daum, about heart disease in women. A few days later, the station called. Rhoda was dead. She'd suffered a massive heart attack. Ironic? Yes. Surprising? Not really.

After all, heart disease is the biggest killer of American women. Yet we seldom hear about it. Rhoda's death made me think about some of the comments I've received as I travel around the country, hoping to create awareness of this killer. Usually, I've been well-received. But occasionally, it's been suggested I should champion another cause. Here are some of the reasons I've been given.

• Women should concentrate on raising funds for breast cancer research because its a more devastating disease. Tell that to the Diabetes Foundation, the National Leukemia Society and several breast cancer groups, for which Rhoda was a tireless fund-raiser.
• Heart disease is "old hat". We should concentrate on spreading information about newer threats, like AIDS. Tell that to all of Rhoda's colleagues at the radio station. She knew AIDS was important; she concentrated on spreading the word about all sorts of important public issues.
• Heart disease is preferable to other diseases because it can be an 'easy death'. Tell that to all the women who, unlike Rhoda, did not die of their heart attack, but suffered strokes and are now disabled.
• Heart disease isn't a major problem because it afflicts mostly elderly women who have lived long, full lives anyway. Tell that to Rhoda's husband, Gene, her children and grandchildren, who had expected to have Rhoda for years.

I've been told all these things, but I don't buy it. Rhoda Daum was 66 years old. she was youthful, energetic, and health conscious. There was no "apparent" reason for her heart disease, and yet now she's died.

We need more publicity, more research, and more dollars spent heart disease. We need to find out if there were things that could have saved Rhoda, and others, from losing their life to heart disease, the Number One killer of American women.

Me? Stop talking about women and heart disease? Don't worry, Rhoda. I'm just getting started - Charlotte Libov

NEW HEART BENEFITS OF ESTROGEN REPLACEMENT THERAPY REPORTED
(Update: Read about newer research on synthetic estrogen
vs bioidentical estrogen)

Pivotal findings on how estrogen replacement therapy (ERT) helps protect postmenopausal women from heart disease were reported here today in a special session on "Featured Research" at the annual scientific sessions of the American Heart Association.

"Short term ERT appears to decrease the workload of the heart, which may contribute to its heart-protective effects above and beyond its known benefits in improving the cholesterol profile," reported Elsa-Grace Giardina, MD, Professor of Clinical Medicine and Director of the Center for Women's Health at Columbia-Presbyterian Medical Center, in a recent interview.

"Our research also suggests that ERT may be of particular benefit to women who are at greatest risk for -- or who already have -- coronary artery disease,"said Dr. Giardina.

Improved understanding of how estrogen works can help physicians better select which women should receive ERT after menopause.

In addition, ERT can aid in the development of new heart-protective medications for men and for those women who can't take estrogen -- medications that might achieve similar benefits.

Estrogen's Mysteries Unfold While various epidemiological studies have shown that ERT markedly reduces the risk of heart disease in postmenopausal women, the mechanism of this benefit has been unknown.The Columbia-Presbyterian project was the first crossover study to evaluate the effects of short-term ERT on cardiovascular hemodynamics. The study enrolled 23 women, whose average age was 57. Seven of these 23 women had coronary artery disease. All were randomized to take for 30 days a daily dose of either 0.625 mg. conjugated oral equine estrogen or an inactive treatment. Then, after four weeks of a washout period, all were crossed over to receive the opposite regimen for another 30 days. All were evaluated before and after each treatment period, both at rest and during exercise echocardiography, which gives a visual picture of how well the heart is working.

Parameters evaluated included:

• The heart rate or pulse,
• Blood pressure,
• Cardiac double product -- a measure of heart workload obtained by multiplying the heart rate by systolic blood pressure,
• Left ventricular end-systolic diameter and left ventricular end-diastolic diameter -- measures of how large the heart is when it contracts and expands.

"During exercise, women taking ERT had a lower cardiac double product, indicating that their hearts did not have to work as hard to maintain circulation," explained Dr. Giardina. "Furthermore, smaller left ventricular end-systolic diameters in the women on ERT indicate that the heart chamber is contracting more effectively and emptying more blood with each beat." It is not clear whether this improved contractility is a direct effect of ERT or an indirect benefit caused by the lower systolic blood pressure seen in the women on ERT.

Dr. Giardina pointed out that many cardiac drugs on the market, such as vasodilators and ACE inhibitors, have similar effects, underscoring the value of these mechanisms in improving cardiac survival.

Greatest Benefits for Those at Highest Risk

Women at the highest risk for coronary artery disease, because of high heart rates or workloads, seemed to derive the greatest benefit from the hormone therapy. For example, while no major change in heart rate was seen at rest in the women as a group, those with the highest resting heart rate at baseline exhibited the greatest reductions with ERT.

"The faster the heart is beating, the harder it is working," said Dr. Giardina. "So this may be another heart-protective mechanism of ERT." In addition, a statistically significant reduction in cardiac double product was seen among those with the highest level at the start of the study. The findings were presented at the meeting by Millie Lee, MD, a research fellow in cardiology at the Center for Women's Health at Columbia-Presbyterian Medical Center.

Note: The statistics and findings in this release update those found in the abstract (#0614), reflecting the most recent work of Dr. Giardina and her colleagues.

PRESENTATION

Beneficial Cardiovascular Hemodynamic Effects of Estrogen Replacement Therapy in Postmenopausal Women. Millie Lee, Robert Sciacca, Stephanie R. Bruce, Henry Wu, Catherine Tuck, Marco R. DiTullio, Shunichi Homma, Elsa-Grace V. Giardina. Center for Women's Health, Columbia-Presbyterian Medical Center, New York, NY.

PAXIL®, FIRST ANTI-DEPRESSANT CLEARED BY FDA FOR PANIC DISORDER

[Note: Many women who've participated in the Power Surge chats, posted in the folder and written e-mail from the Web site have complained of depression, panic attacks and medications they take for same, such as Paxil, Zoloft, Prozac. In view of this, the following article should be of interest to many of you. Thanks - Dearest]

PHILADELPHIA, May 7, 1996 -- Paxil(R) (paroxetine hydrochloride) was cleared by the U.S. Food and Drug Administration today for the treatment of panic disorder, SmithKline Beecham (NYSE: SBH) announced. Panic disorder is a chronic, disabling condition that will affect 3 to 6 million Americans at some time in their lives.

Paxil is the first and only antidepressant indicated for treating panic disorder and the first new drug therapy to be cleared for panic disorder in nearly a decade. Paxil belongs to the class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs).

"In clinical trials, at end point, three out of four patients treated with Paxil were free of full panic attacks," said David Wheadon, MD, vice president of CNS Products, Clinical Research and Development at SmithKline Beecham. "We believe that Paxil will provide physicians the ability to significantly relieve the symptoms of this disorder and get their patients' lives back on track."

Panic disorder is characterized by recurrent panic attacks. A panic attack is a sudden, unprovoked episode in which sufferers experience physical symptoms such as a racing, pounding heartbeat, chest pain, breathlessness, and choking and may fear they are losing control or are in imminent danger of dying. Panic disorder is diagnosed when a person has:

• Persistent anxiety about having another attack,
• Concern over the implications of the attacks or their consequences, including fear of life-threatening illness or "losing control," and
• Behavioral changes due to the attacks, including avoidance of everyday activities.

The clinical studies showed that Paxil provides effective short- and long-term treatment for panic disorder," said Jack Gorman, MD, professor of clinical psychiatry at Columbia University. "Many patients suffer for years with this chronic condition before being diagnosed, and long-term therapy is often needed."

Women are twice as likely as men to suffer from panic disorder, and the most common age of onset is the late teens and early twenties. Yet, panic attacks and panic disorder are found in people of all ages. Despite its prevalence, panic disorder is underdiagnosed, according to the National Institute of Mental Health, which estimates that only one out of three panic disorder sufferers have been correctly diagnosed and treated.

Clinical Trials

In one 10-week double-blind clinical study, 76% of patients treated with 40 mg per day of Paxil were completely free of full panic attacks at the end point, compared with 44% of patients who received placebo. Patients who responded to Paxil during the initial 10-week phase and a 3-month double-blind extension phase were randomly assigned to continue on Paxil or be switched to placebo for an additional 3 months. Of the patients switched to placebo, 30% experienced a relapse, as compared with only 5% of those who were treated with Paxil.

Paxil was well tolerated in clinical trials. Side effects with an incidence of 10% or greater and at least twice that of placebo were abnormal ejaculation, sweating, and weakness.

Advantages of Paxil

For many years, the only drug indicated for panic disorder was the benzodiazepine tranquilizer alprazolam. However, alprazolam is associated with dependence and is not indicated for long-term treatment of this chronic condition; nevertheless, until today physicians have had little alternative. Now, however, they can prescribe Paxil, which has not been associated with the development of dependence in clinical trials and is indicated for long-term treatment of panic disorder.

In addition, alprazolam is not indicated for major depression, and as many as 65% of patients with panic disorder may also suffer from depression. Paxil is indicated for the treatment of depression as well as panic disorder.

For the treatment of panic disorder, the recommended target dose of Paxil is 40 mg per day. The starting dose is 10 mg per day, and dosage should not exceed 60 mg per day. Paxil is available in 10-, 20-, 30-, and 40-mg tablets.

Indication for Obsessive-Compulsive Disorder

Paxil also received FDA marketing clearance today for the treatment of obsessive-compulsive disorder (OCD). Obsessions are recurrent and persistent thoughts that are intrusive and inappropriate, as well as distressing or anxiety-provoking. Compulsions are repetitive behaviors such as hand-washing or mental acts such as repeating words silently, and are aimed at reducing the distress or preventing some dreaded event.

Paxil is the only SSRI that has demonstrated long-term maintenance of efficacy in a six-month relapse-prevention clinical trial. This is important because OCD is a chronic condition and often requires long- term treatment.

Paxil was also well-tolerated in clinical trials in OCD. In these trials, side effects with an incidence of 10% or greater and at least twice that of placebo were sleepiness, nausea, abnormal ejaculation, dry mouth, constipation, dizziness and tremor.

The recommended dosage of Paxil in the treatment of obsessive-compulsive disorder is 40 mg daily. The starting dose is 20 mg per day, and dosage should not exceed 60 mg per day.

SmithKline Beecham -- one of the world's leading healthcare companies -- discovers, develops, manufactures, and markets pharmaceuticals, vaccines, over-the-counter medicines, and health- related consumer products, and provides healthcare services, including clinical laboratory testing, disease management, and pharmaceutical benefit management.

RELIANCE® DOCUMENTED AS EFFECTIVE FOR STRESS URINARY INCONTINENCE

ORLANDO, Fla., May 8, 1996-- According to two separate presentations today at the 91st annual meeting of the American Urological Association in Orlando, women who used the Reliance(R) Urinary Control Insert for managing stress urinary incontinence (SUI) experienced dramatically reduced urine leakage across a broad range of everyday physical activities and, as a result, reported significant improvement in their quality of life.

Based on a nationwide, multicenter study designed to determine the safety and efficacy of the Reliance Insert, David Staskin, M.D., director of the Urodynamics and Incontinence Center at Harvard Medical School's Beth Israel Hospital, demonstrated that four out of five women who used the self-administered device were completely dry throughout 12 months of use, according to objective pad weight tests. He concluded that the Reliance Insert is a highly effective means of managing stress urinary incontinence and is associated with a high level of user satisfaction.

Staskin also presented key findings of a patient questionnaire completed after 12 months of device use, including:

1. 97% of patients would recommend the Reliance Insert to another sufferer.
2. 90% had moderate to very significant improvements to their quality of life.
3. 82% of patients felt more confident participating in outdoor activities.

Grannum R. Sant, M.D., professor and chairman at interim of the Department of Urology at Tufts University School of Medicine, presented data culled from patient voiding diaries documenting the impact of device use on patients' quality of life during the same 12-month period.

"The patient is a good judge of her incontinence symptoms and the effectiveness of the treatment she chooses," said Sant. "And regardless of their age or the severity of their condition, patients in our study have confirmed in vivid detail what the data itself has already told us, which is that, by both subjective and objective measures, the Reliance Insert is an effective, non-surgical option for the management of stress UI. Symptom improvement measured in the voiding diaries is parallel to results of standardized pad weight studies and the physical functioning measure of a validated SF36 Quality of Life survey."

"Perhaps of equal importance," Sant continued, "is that the device enables women to resume a range of physical activities -- from sitting, standing, and walking to high-impact exercise -- that are integral to the quality of their life and health."

Stress urinary incontinence, the involuntary loss of urine during coughing, laughing, sneezing, exercising, or other physical activity that increases abdominal pressure, affects an estimated 5.4 million women in the U.S.

The Reliance Insert, developed by UroMed Corporation of Needham, MA, is intended to provide the appropriate female incontinence sufferer with lifestyle benefits similar to those provided by a tampon, offering physical and psychological advantages not available through other means, which currently include diapers or more invasive options such as implants and surgery.

The Reliance Insert is a discreet, disposable device about one-fifth the size of a tampon. It is inserted by the patient into the urethra, and a small balloon tip is inflated using a removable, reusable applicator. The balloon rests above the bladder neck, and is designed to immediately prevent the flow of urine. When the patient wants to void, she pulls an attached string, which deflates the balloon, then removes and disposes of the device. Adverse events associated with use of the Reliance Insert were well within the range expected, easily managed, and decreased in frequency over the course of the study. Already in use in England, Germany, Scandinavia, and the Netherlands, the Reliance Insert is currently an investigational device in the United States. A Section 510(K) Notification has been filed with the U.S. Food and Drug Administration and is currently under review.

UroMed Corporation (Nasdaq: URMD) was founded to develop, manufacture and market products for the management of urological and gynecological disorders. The company's first product, the Reliance Urinary Control Insert, is a balloon-tipped, single-use device intended for the management of certain types of female urinary incontinence. According to company estimates, urinary incontinence (UI), the loss of bladder control resulting in involuntary leakage of urine, afflicts approximately 26 million women in the United States, Japan and selected countries in Europe. UroMed's Reliance Insert is designed for an estimated target market of approximately three million of these women who suffer from certain types of UI and seek to maintain their active lifestyles. UroMed has designed the Reliance Insert in order to provide the appropriate UI patient, who now typically wears diapers or pads, with lifestyle benefits similar to those conferred by a tampon in the case of menstruation.

Risks/Benefits of Hormone Replacement Therapy Examined

Women at high risk for coronary heart disease or osteoporosis may be the ideal beneficiaries of long-term hormone replacement therapy (HRT), according to research presented this week at a special meeting of the North American Menopause Society (NAMS).

(Dearest note: This article was written prior to the WHI (Women's Health Initiative) Study that was abruptly halted in 2002, in great part because it negated the above findings regarding heart disease and breast cancer).

But researchers cautioned that HRT used for many years could increase the risk of breast cancer.

"The question is still scientifically up in the air and until we have a clear perspective on the situation, we must share our uncertainties and concerns with our patients," said Dr. Isaac Schiff, professor of Gynecology at Harvard Medical School. "And along with our patients, we must squarely and solemnly face a decision-making process that weighs short- and long-term gains versus short- and long-term risks."

Because of conflicting information about breast cancer risk, NAMS convened a panel of 10 of the country's leading experts on various aspects of long-term HRT at a special colloquium prior to the start of their sixth annual meeting held in San Francisco September 21-23.

Trudy Bush Ph.D., a professor at the University of Maryland at Baltimore School of Medicine, stated that despite 38 studies on the subject, "We really don't know how much, if any, HRT increases the risk of breast cancer, and it's unlikely that more studies will be able to tell us."

Dr. Deborah Grady, an associate professor of Epidemiology and Medicine at the University of California in San Francisco, was more definite about the risk. She said that longterm use - 15 years - substantially increases the risk of breast cancer.

As an impartial resource on all aspects of menopause, the NAMS annual meeting attracted 1,100 physicians and allied health professionals from more than 50 countries. Later this year, NAMS will be embarking on an intensive health education campaign for both consumers and providers later this year.

The need is pressing given the following statistics presented at the program:

Women over age 45 represent 45% of the annual 1.3 billion physician/patient contacts.
• Currently women constitute 59% of the U.S. population over age 65 and 72% of the over 85 population.
• By the year 2000, there will be more than 50 million American women over age 50.

Founded in 1989, NAMS is the country's only nonprofit organization dedicated to furthering the knowledge of the climacteric and improving the care of menopausal women. Its 2,000 members include leaders from around the world in the field of menopause, including physicians, nurses, scientists, anthropologists, sociologists, epidemiologists, dietitians and psychologists. The diversity of its membership allows NAMS to be the preeminent resource on all aspects of the climacteric to both healthcare professionals and to the public.

POWER SURGE PHYSICIANS/EXPERTS ANSWER E-MAIL

In Power Surge, we share a great deal of E-Mail as well as messages posted in the Power Surge/Menopause folder in Women's Interests. Herewith I've shared responses from some of our Power Surge experts.

DR. ALLAN AVEN/DOC ALLAN ON ORVETTE BC PILLS

Ovrette is a birth control pill containing only the progesterone, norgestrel. As a birth control pill, it is effective (but not as good as the combo pills) and is associated with easy breakthru bleeding and significant mood swings. It has not been approved for use in menopausal treatment but studies are being done not only with norgestrel, but with norgestimate and other progestins in combination with synthetic estrogen (17 beta estradiol). Most studies are being done using 1 mg of estrogen (this has been determined to be the "average" dose needed by "most" women).

The dose of the progesterone is the variable due to the fact that most of the problems surrounding HRT are those of bleeding which is one of the problems when adding progesterone to the menopausal regimen. Medroxyprogesterone (provera, amen, cycrin) has been studied the most - but has not done very favorably in terms of side effect profile; it is still considered the "gold standard" of progesterone therapy.

Natural micronized progesterone has not been studied to the same degree and dosing, effectiveness, and long term use are not completely understood. If a woman wasn't doing well on current approved therapies, she certainly could try these other progesterones, but only with informed consent and instructions to report untoward effects immediately. Also the use of serial transvaginal ultrasounds to watch the endometrial thickness and occasional endometrial biopsies would help to prevent anxiety over the "precancer" issue of ineffective progesterone dosing.

Once again, I reiterate, the treatment of menopause should be individualized to the needs of the patient - those needs being perceived by the patient and in consultation with a concerned and knowledgeable physician.

(N.B.: The PEPI studies just confirm alot of what we notice in our day to day practices.)

Allan Aven, M.D./Power Surge Consultant

ON EMPOWERING OURSELVES By Diane Batshaw Eisman, M.D.

When Dearest asked if I would put down a few words for Power Surge, I thought of many things I wanted to say. I thought about a few tips on keeping our weight down or reviewing some of the things we know about hormone replacement therapy or women and heart disease or unusual medical facts. And then I stopped. Because two words sum all of it up:

Choice.

Empowerment.

When my daughter was ten, she wrote an essay in school. Now, I look back and realize that this tiny young woman-ling got it! Her essay was about the women's movement. While I was struggling with the guilt of being a new young doctor, while the house lay in a muddle with meals unplanned, clothes unwashed this sprout really got it!

She didn't focus on our fight for equality. Or list the women who were now becoming powerful writers, political leaders or scientific creators. She spoke of Choice. And, oh yes, that's no typo. The choice she spoke about came with an elegantly strong capital "C." She understood that the women's movement didn't mean every woman had to run out and have a career (even though her role model did just that). Nor did she have to embrace feminism. She wrote of the beauty we women were fighting for and winning. She wrote of the joy and power in knowing that we could choose.

Her paper elevated the woman who called herself 'housewife.' My daughter spoke of how this woman was able to make an honorable choice for herself, a choice from her heart. She loved being home, creating a nest, teaching her children. There was such empowerment in her weaving the outside world of current events into her home, and power in being able to create a loving sanctuary for her family. Power and choice in all that she created.

And the woman who chose career or career and home was equally powerful. She Chose from her heart and therefore was empowered.

And that's it. We empower ourselves. We ennoble ourselves when we choose honestly our own paths. And when we hold our heads up high and grin at that old dumb monster called guilt. We have chosen to stand up tall and proud, rich in our own power.

Diane Batshaw Eisman, M.D./Power Surge Consultant

DR. HOWARD GELFAND/DOC HOWIE ON HORMONE THERAPY

I recently read the letter from the woman who was told to be post menopausal by her Gyn. There are several important points of information that are missing and would be helpful.I'll go through the litany and let you refer the info or, if she so choses, the woman can contact me directly at AOL.

I have had similiar cases where a relatively young woman has stopped having periods. Sometimes the problem is stress related, but this will revert back to normal within a short time. Other times there may be a problem gynecologically such as a tumor in the uterus or a cyst or neoplasm on the ovary which could either affect the hormones of the woman or mechanically prevent the flow of the menstrual blood. An ultrasound of the pelvis would be important to determine that.

Secondly I would look to check several different hormones. The first batch would include the thhyroid hormones (especially if the woman is gaining weight.) And of course, the LH/FSH need to be checked. If these are menopausal after several months of repeated checking, then the diagnosis of "premature" menopause must seriously be considerered.

Many, many studies have shown that estrogen replacement in the menopausal female prevents osteoporosis, heart disease and probably intestinal Cancer. Estrogen by itself, however, increases a woman's chance of getting cancer of the lining of the uterus (endometrial cancer). Therefore, we give progesterone along with the estrogen to prevent the cancer from forming.

Estrogen does not cause a woman to gain weight. The weight gain that is seen during the menoppause is from the slowing of the bod\y's metabolism. Estrogen tends to increase the metabolism. Progesterone, iin its many forms, can make the body hold water, thus the reports of 5-10 pounds of weight gain when the birth control pil or HRT is prescribed.

If this woman does not want to take hormone replacement therapy (HRT) at the moment perhaps her physician would consider putting her oral contraceptives (birth control pills) if she doesn't smoke. Many studies seem to indicate that the hormones in the birth control pills probably would protect a woman's bones much like the effect of HRT (but they are different types of hormones). While on the OC's the woman could undergo hormone studies every six months or so to determine if she i still menopausal.

The bottom line, however, is that some woman will be menopausal sooner than others and that is a fact of life. All we can do when that happens is try to prepare and keep that woman healthy for all the years left of her life- in most cases many more.

Howard Gelfand, M.D./Power Surge Consultant

MENOPAUSE SOCIETY COMMUNICATIONS: HRT Uptake and Compliance

The benefits of long term HRT have been proven but there is great variation in HRT uptake as shown by Odden et al.'s European study. Similar variation existed in the USA. (Ravenikar et al).

• The Massachusetts study showed 20% of patients never cashed in their prescriptions.
• In the UK J. Coope's study revealed 78% took HRT for one year but only 19% carried on for five years.
• My study is a retrospective analysis of HRT users for long term compliance in a general practice setting.

HYSTERECTOMY EDUCATIONAL RESOURCES AND SERVICES FOUNDATION

• Mission

The Hysterectomy Educational Resources and Services (HERS) Foundation is a nonprofit organization that provides information to the general public about hysterectomy (surgical removal of the uterus) and oophorectomy (removal of the ovaries).

• Services

HERS provides telephone counseling and support services to women who are scheduled to have or who recently have had a hysterectomy.

HERS has a lending library that contains medical literature on a number of conditions and diseases that affect women's health, including fibroids, hyperplasia, and ovarian conditions. Publications

HERS distributes a quarterly newsletter. Printed material is available on surgical procedures, the aftereffects, and coping with the consequences of surgery. A list of other publications is available on request.

My special thanks to Surgette, Postrain, for passing along this info :)

BOOKS - PERSONAL GROWTH

Note: Previous newsletters recommend a plethora of books on menopause, but as we all know, so many other changes are taking place simultaneously...while .menopause impacts on every nuance of our lives. Here are some excellent books with which to empower yourself.

• Never To Be A Mother - Linda Hunt Anton
• A Woman's Spirit - Anonymous
• Each Day A New Beginning - Anonymous
• The Woman's Comfort Book - Jennifer Louden
• Keys to the Open Gate: A Woman's Spirituality Sourcebook - Kimberley Snow
• Woman at the Edge of Two Worlds - Lynn V. Andrews
• Too Good For Her Own Good: Searching For Self and Intimacy in Important Relationships - By: Claudia Bepko & Jo-Ann Krestan
• The Relaxation & Stress Reduction Workbook - Martha Davis, Ph.D., Elizabeth Robbins Eshelman, M.S.W., & Matthew McKay, Ph.D.
• A Little Book of Forgiveness - D. Patrick Miller
• Liberating the Adult Within - Helen Kramer
• The Lessons of Love - Melody Beattie
• Alternative Pathways to Healing - Kip Coggins
• Mastering Your Moods - Dr. Melvyn Kinder
• In Search of Values - Dr. Sidney B. Simon
• At the Speed of Life - Gay Hendricks,Ph.D., & Kathlyn Hendricks,Ph.D.
• Breathing Into Life - Bija Bennett
• Drama of the Gifted Child: The Search for the True Self - Alice Miller

BOOKS ABOUT DEPRESSION

• Depression Getting Control - By: Lee Baer, Ph.D.
• You Mean I Don't Have To Feel This Way? New Help for Depression, Anxiety, and Addiction - By: Colette Dowling
• You Are Not Alone - By: Julia Thorne, with Larry Rothstein Soft Cover
• I Can't Get Over It: A Handbook for Trauma Survivors - By: Aphrodite Matsakis, Ph.D.
• Triumph Over Fear - By: Jerilyn Ross
• Reason To Live - By: Melody Beattie, General Editor
• When Someone You Love Has a Mental Illness: A Handbook for Family, Friends, and Caregivers - By: Rebecca Woolis, M.F.C.C.
• The Depression Workbook: A Guide for Living With Depression and Manic Depression - By: Mary Ellen Copeland, M.S. Soft Cover Audio Cassette
• Overcoming Depression, revised ed. - By: Demitri Papolos, M.D. & Janice Papolos
• Driven to Distraction - By: Edward M. Hallowell, M.D. & John J. Ratey, M.D.
• Silencing the Self: Women and Depression - Dana Crowley Jack

BOOKS ABOUT WEIGHT ISSUES

• Weight issues Fat and Furious: Women and Food Obsession - By: Judi Hollis, Ph.D.
• Emotional Weight - By: Colleen A. Sundermeyer, Ph.D.
• Losing Your Pounds of Pain - By: Doreen Virtue, Ph.D.
• Fat is a Feminist Issue - By: Susie Orbach
• You Can't Quit 'til You Know What's Eating You - By: Donna LeBlanc, M.Ed.
• Food Addiction: The Body Knows - By: Kay Sheppard
• Shame and Body Image - By: Barbara McFarland, Ed.D and Tyeis Baker-Baumann, M.S.

BOOKS ABOUT GRIEVING AND LOSS

• Giving Sorrow Words - By: Candy Lightner & Nancy Hathaway
• The Mourning Handbook - By: Helen Fitzgerald
• The Courage To Grieve - By: Judy Tatelbaum
• A Woman's Book of Grieving - By: Nessa Rapoport
• A Time To Grieve - By: Carol Staudacher
• On Death and Dying - By: Elisabeth Kubler-Ross Soft Cover Audio Cassette: 2 tapes
• How To Survive the Loss of a Love - By: Melba Colgrove, Ph.D., Harold H. Bloomfield, M.D. & Peter McWilliams Hard Cover - Audio Cassette: 2 tapes
• The Grief Recovery Handbook - By: John W. James & Frank Cherry
• Life is Goodbye, Life is Hello: Grieving Well Through All Kinds of Loss - By: Alla Renee Bozarth, Ph.D.
• How to Go On Living When Someone You Love Dies - By: Therese A. Rando, Ph.D.

BOOKS ABOUT RELATIONSHIPS

• Men, Women and Relationships - By: John Gray, Ph.D.
• Boundaries and Relationships: Knowing, Protecting and Enjoying the Self - By: Charles L. Whitfield, M.D. Soft Cover
• Conscious Loving - By: Gay Hendricks, Ph.D. & Kathlyn Hendricks, Ph.D.
• Love & Betrayal - By: John Amodeo, Ph.D.
• The Dance of Intimacy - By: Harriet Goldhow Lerner, Ph.D.
• The Dance of Anger: A Woman's Guide to Changing the Patterns of Intimate Relationships - By: Harriet Goldhow Lerner, Ph.D.
• The Dance of Deception: Pretending and Truth-telling in Women's Lives - By: Harriet Goldhor Lerner, Ph.D.
• Men Are From Mars, Women Are From Venus - By: John Gray, Ph.D.
• Intimacy Struggle - By: Janet G. Woititz
• Soul Mates - By: Thomas Moore

MISCELLANEOUS BOOKS OF INTEREST

• Working Ourselves to Death: The High Cost of Workaholism & the Rewards of Recovery - By: Diane Fassel, Ph.D.
• The Addictive Organization - By: Anne Wilson Schaef and Diane Fassel
• Working From the Heart - By: Jacqueline McMakin, with Sonya Dyer
• Small Decencies - By: John Cowan
• Zen and the Art of Making a Living - By: Laurence G. Boldt
• Discover What You're Best At - By: Barry and Linda Gale
• Do What You Are - By: Paul D. Tieger & Barbara Barron-Tieger
• The Best Home Businesses for the 90's - By: Paul and Sarah Edwards

HUMOROUS BOOKS: LAUGH AT THE ABSURDITY OF IT ALL

• Codependent For Sure: An Original Jokebook - By: Jann Mitchell
• The Funny Side of Parenthood: The Best Quotes, Quips & Rhymes - By: Bruce Lansky
• Mothers and Daughters - By: Michael Cader
• Babies & Other Hazards of Sex - By: Dave Barry, illustrated by Jerry O'Brien
• Rationalizations for Women Who Do Too Much: While Running With the Wolves - By: Allison McCune and Tomye B. Spears
• Meditations for Men Who Do Next to Nothing (and would like to do even less) - By: Lee Ward Shore
• Meditations For Cats Who Do Too Much - By: Michael Cader
• I'm Good Enough, I'm Smart Enough, and Doggone It, People Like Me!
• Daily Affirmations by Stuart Smalley - By: Al Franken
  
  

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These questions are not intended to make you feel bad or guilty. They should serve as reminders in helping you see how you are currently caring for yourself.

Books! Books! Books!