Everything You Need To Know About Menopause And Your Hormones
May 19th, 9:15 PM, ET

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Everything You Need To Know About Menopause

Read more about Phillip Warner, M.D.

OB-GYN and Power Surge's very popular,
Ask Dr. Warner

* * * * * * * * * * * * * * * * * * * *

Join us Thursday, May 19th,
9:15 PM (ET)
Phillip Warner, M.D.
will answer your questions about Menopause,
Midlife Health Issues, Bioidentical Hormones,
And Other Natural Menopause Treatments

Phillip O. Warner, M.D. OB-GYN and Power Surge's very popular, Ask Dr. Warner was in private practice in Northern California for 32 years and is the former director of the Menopause Institute of Northern California. He is a Diplomat of the American Board of Obstetrics and Gynecology, a member of the North American Menopause Society, and has done clinical research for the pharmaceutical industry. Dr. Warner's special interest is in hormone imbalance therapy. The use of hormones when indicated, should be in the form of bioidentical hormones which are natural to the human female. He found that a number of his patients did not respond well to the standardized treatment. By individualizing treatment, Dr. Warner was able to dramatically improve his patients' quality of life. Much of Dr. Warner's career has been spent empowering women through education and individualized treatment to stay healthy with alternative therapies including nutritional supplements, herbal therapy, acupuncture and good dietary intake. These therapies, combined with weight control, exercise regimens, stress reduction and avoidance of toxic substances can lead to a longer symptom-free postmenopausal life.

Dr. Warner wrote: "The prescribing of oral Premarin by physicians for estrogen deficiency has evolved over the years as an automatic ‘Pavlovian’ response without any thought to giving individual treatment. Premarin is not a ‘natural’ substance in human consumption, nor is it the best choice of treatment despite its wide usage. The notion that a substance derived from horses is ‘natural’ to the human female is a tribute to 50 years of successful advertising."

Dr. Warner's commitment to research, patient education, and individualized treatment, led to his current role providing specific consultation to patients. This enables women to receive individual answers to questions as Power Surge's, Ask Dr. Warner.

Thursday, May. 19th at 9:15 PM (ET) in
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Read the transcript here

Answers To Women's Questions From Power Surge's Ask The Gynecologist, Phillip Warner, M.D.

Q.) I was in menopause for 11 months. During that time, I did not take any hormones, just Progresterone cream occassionally to help night sweats. However, during that 11 months, my depression, aches and pains, etc., were debilitating. When I started full, normal bleeding cycles again and have now had 3 of them. I feel so good again, but I am now overdue by 2 weeks and already the debilitating symptoms return. I'm scared. I'm thinking of using HRT so that I can keep my life this time.

A.) There are several things I must tell you so that you will not be confused in understanding what is going on with your hormones. The first thing is that menopause is the complete shutting down of the ovaries so that your make no more estrogens, progesterone and testosterone from the ovaries. When this happens, you will never again have periods.

You were not "in menopause" for 11 months otherwise you would not have started bleeding again. You were in perimenopause in which the ovaries are still making hormones but at lower amounts and this causes the symptoms you described. When you started bleeding again and felt well, the ovaries were making more hormones. Now you are once again making less hormones and soon you will stop forever.

You need to have a doctor prescribe bioidentical estrogens, progesterone and testosterone in the right doses for you which will replace the lost ovarian hormones. When you do this, you will feel well. There is nothing to be scared about when you replace with bioidentical (exactly like your own) hormones. You need to be scared if you take hormones like Premarin and Provera.


Q.) I have been on the CombiPatch for the last three years and am trying to limit it's use to once every two weeks rather than twice a week. Lately, I've been having tingling in my feet and a feeling of "internal tremors" throughout my spine, neck and pelvis, especially when trying to sleep. Have you heard of symptoms like these being linked to menopause? I started menopause at 43 and am now 53, and the hot flashes still go on and on as soon as I go too long changing the CombiPatch. I'm a bit scared with these new symptoms. Thanks for any input!

A.) I am not sure that your "internal tremors" are related to your hormonal deficiency or your irregular use of the Combipatch. However, your hot flashes are certainly due to the deficiency of estrogen in your blood stream.

You need to change your hormonal replacement treatment. You need to start bioidentical estrogen, progesterone and testosterone in the proper doses and you need to have a prescription for these hormones together in the form of a sublingual tablet. This will give the best results for you and relieve all of your symptoms.

The Combipatch contains "Counterfeit" progesterone and not bioidentical progesterone. This results in poor absorbtion and less than ideal results. There is no reason to use this patch when you have the bioidentical hormones easily available for use.


Q.) I saw you at a meeting in Vancouver, WA. You put me on HRT - 3 hormones. I stopped for 6 weeks. I still sweat but don't really have hot flashes. Is it the hormones that cause my heart to beat funny and quite rapid? I've checked and sometimes it's anywhere from 80 to 115 resting. It kind of flips and flops too. No pain. Thank you so much.

A.) Since you are describing abnormal heart rate and rhythm, it is best to make an appointment with a cardiologist, have an electrocardiogram (ECG) and obtain expert advice.


Q.) I am 50 & have a 6cm fibroid tumor located behind my uterus & pressing against my bowel causing more discomfort than pain. My bowel movements are flat. I haven't had my period for 7 months & I'm scheduled for another ultrasound next month to see if the tumor has shrunk. My doctor says I will have to have a hysterectomy in order to have the tumor removed. I've had hot flashes for the last couple of years. I just started getting night sweats this past month that wake me several times a night. Is there any product you can suggest I use so the tumor doesn't get any larger. Thanks, Barb

A.) Fibroid tumors of the uterus are stimulated by the estrogens made by the ovaries. Since you are now menopausal (no periods for 7 months and having hot flashes) you are making very little estrogen and, therefore, the fibroid tumor should shrink on its own. If it continues to cause bowel discomfort, it can be removed surgically. You do not need to have a hysterectomy, however. The surgery can be done by laparoscopy and only the tumor itself is removed. This can be done as ourpatient surgery with minimum recovery time.


Q.) I have been on the pill for 15 years and recently stopped (using alternative birth controll). I had one period after being off the pill and now for 2 months nothing. I also am retaining fluid in my fingers intermittently - no real pattern. Are these normal symptoms after stopping the pill? (I was on a low does BCP, Alyesse)

A.) After coming off the pill, it is not uncommon to miss periods and this may last for months. This is called post pill amenorrhea. Sometimes, missing a period after stopping the pill means you are pregnant, so do not overlook that possibility.


Q.) I am 51 years old, have not had a period for 3 years, but still have minor menopausal symptoms. When are you considered post menopausal? Could I stil be perimenopausal? Is is common to have a simple ovarian cyst after being post menopausal?

A.) At age 51, with no periods for 3 years, you are menopausal. This means that your ovaries are no longer making hormones, namely estrogens, progesterone and testosterone and no longer have any eggs. Once your ovaries have shut down, you are menopausal forever. The symptoms of menopause may last different amounts of time, or may last forever. You certainly need to start bioidentical hormone replacement treatment for relief of symptoms as well as improving your general health. You should not show any type of ovarian cyst on ultrasound after you are menopausal.


Q.) I am a 46 year old and have been experiencing perimenopause symptoms since 1999. The works but mainly late and missed periods -- until recently I started and when it was time to end (usually 6 days) the damn broke. After 11 days like this I visited my gynecologist. she Prescribed Mircette. I'm not crazy about taking B.C since I've had a tubal, but was desperate to stop bleeding. Any Thoughts on alternative treatment?

A.) You are indeed having perimenopausal symptoms and that also means that this is causing your bleeding dificulties. You need to start bioidentical progesterone supplementation given to you by prescription. The doctor treating you must be familiar with perimenopause treatment. I totally agree that you should NOT be taking birth control pills.


Q.) I had irregular bleeding for 7 weeks. My doctor put me on 10 mg of medroxyprogesterone for 7 days. He said I would get my period immediately after stopping the medication. I have been off the meds for 7 days and I haven't gotten a period. Should I be worried?

A.) You had irregular bleeding for 7 weeks. There are many reasons this could happen. I do not agree with your doctor`s treatment of using the medication. The fact that you did not get your period means nothing. You need to have further tests and I recommend a competent gynecologist. You need not be worried since this does not appear to be a serious problem.


Q.) My doctor recently put me on Prometrium, but I am very afraid to take it. I had a lot of trouble with Progestin and don't want to experience the same side effects which were depression and extreme sensitity to noise. I also felt a somewhat out of body experience twice. I was wondering if there is a way to gradually take this pill, such as taking a little bit of it and building up to an entire pill. I take 100 mg. Thank you for your input.

A.) Your experience with Progestin (the most common brand name is Provera) is common and many women have the depression and sensitivity you described. Prometrium, however, is bioidentical progesterone and therefore just like the progesterone produced by your ovaries. It is NOT Progestin. The dose is important so you should proceed slowly.


Q.) I'm 48 years old. Last period was aproximagely 10 months ago. I've been on bio-identicals for about two years. Tri-est, than switched to bi-est because I read it was probably safer. I guess because it was weaker it stopped relieving symptoms. I was up to 6 mg. Capsules with 100 mg. progesterone Caps. Primary gave up. My new doctor put me on Climara patch o.5 Mg., 200 mg progesterone caps. I'm experiencing extreme abdominal bloating and weight gain 20 lbs in last year. No one can seem to tell me why I am bloating. Last ob visit everything was normal. Any suggestions?

A.) The most obvious answer to your dilemma is to take the estrogen and progesterone in a non-oral form that will not enter the stomach and intestine. In this way you should avoid the abdominal bloating and also improve the relief of symptoms.

The best non-oral method is the sublingual tablet. Therefore, you need to have your doctor prescribe sublingual tablets of estradiol and progesterone which should be effective and have no side effects.


Q.) Does estriol stimulate fibroid growth? I have been using .0375 Vivelle patch and 100 mg natural progesterone cream daily. I'm considering switching to bi-est because I have read estiol is a good estrogen. Also, is it common to have a slight period each month when using this combo daily?

A.) Estriol is the weakest of the 3 estrogens and has little effect on the uterus and little effect on the fibroids in average doses. It also does not help with estrogen deficiency problems such as hot flashes. There is no reason for you to switch to bi-est.

Since you are having a slight period each month, you need 200 mg of progesterone daily which will stop the bleeding and also help to shrink the fibroid.


Q.) I was told by the women on Power Surge to contact you about this. My husband and I have always had a very good sex life and now I have desire only once in a while. My question is, will my desire return after I have reach menopause, or am I doomed to be this was the rest of my life? By the way, I am taking Premarin and Provera.

A.) If you are taking Premarin (horse estrogens) and Provera (bad synthetic progesterone), you must be menopausal and not making your own estrogens, progesterone and testosterone from your ovaries. Stop the Premarin and Provera since it has been proven that those drugs will increase your chances of getting heart attacks, strokes and breast cancer. Start taking your own (bioidentical) estrogens, progesterone and testosterone which are available by prescription. When you replace your testosterone in the proper dose your sex life will return to normal. You are certainly not doomed to being unable to desire sex. You will have the pleasure of having sex with your husband for the rest of your life. Get started on the bioidentical hormone replacement treatment.

Bio-Identical Hormones For Hormone Replacement Therapy

The abrupt cessation of a branch of the Women's Health Initiative Randomized Controlled Trial (WHI) (a study funded by the NIH, National Institute of Health) caused a media frenzy and raised concerns regarding Hormone Replacement Therapy (HRT) by both the professional and lay community. Interestingly, this WHI study was actually one of two studies which had results published at approximately the same time. The other study was the The Heart and Estrogen / Progestin Replacement Study Follow-up (HERS II) study.

The WHI trial consisted of 16,608 post-menopausal women age 50-79 years with an intact uterus at baseline who were recruited by 40 US clinical centers from 1993-1998. The women took Premarin 0.625 milligrams plus Provera 2.5 milligrams (a combination called PremPro) each day, or they took a placebo (a similar pill with no medication) each day, and were unaware of which pill they were taking. The Women's Health Initiative was asking the question "Does hormone replacement with PremPro decrease the risk of chronic disease in healthy women who have their uterus and ovaries."

This study was ended early on May 31, 2002 after 5 years due to an increase in the risk of breast cancer of 26% in the group receiving PremPro. Because this study was ended early, it is difficult to interpret the results for heart disease. However, preliminary results (those that were seen with the amount of time that elapsed during the study) demonstrated that there was an increased risk for non-fatal heart attacks, stroke, and blood clots (deep vein thrombosis -- DVT) and pulmonary embolism (PE)). Again, it is important to note that because this study was ended early, it is difficult to determine whether these "heart effects" would have been reduced with continued treatment once the "initial high risk period" of treatment is complete. Benefits from treatment in this study included a reduction in fractures, conferring protection from osteoporosis or "bone disease". The authors of this study commented that "the results of this study do not necessarily apply to other formulations of oral estrogens and progestins (natural progesterone)." In addition, they stated that "it remains possible that estradiol with progesterone, which more closely mimics the normal physiology and metabolism of endogenous sex hormones, may provide a different risk-benefit profile".

The recently published HERS II study consisted of 2,321 post-menopausal women in which treatment with hormones (most patients received Premarin 0.625 mg) was compared to no hormone treatment to evaluate the benefit on coronary heart disease, as well as non-cardiovascular effects such as cancer. This study demonstrated no differences with regard to cardiovascular (heart) effects for patients who were treated with hormones versus patients who received no treatment with hormones. Additionally, this study showed that after an initial treatment period of 2 years with hormones, the risk of blood clots declined to a non-significant difference. Therefore, long-term there is no increased risk of blood clots. The HERS II study also demonstrated that there were no differences between the hormone group and the placebo (sugar pill) group in the incidence or occurrence of any types of cancer.

Both of these studies strengthen the idea that Hormone Replacement Therapy (HRT) should be in the form of Bio-Identical Hormones (or Human Identical Hormones - HIH), and not products like PremPro and Premarin that are totally foreign to the human female. The concept that estrogens and progesterone coming from horse placentas or created in the laboratory will have positive long-term benefits in the human female simply makes no sense. The Bio-Identical Hormones match exactly the estrogens and progesterone made by the ovary, and therefore fit exactly on the cell receptors as nature intended. These hormones are extracted from various plants and have been available by prescription for many years.

There have been some studies with positive benefits of bio-identical hormones in reducing the risk of heart disease, osteoporosis, stroke, cancer and Alzheimer's disease. Generally, these studies showed no increased risk of breast or endometrial cancer. Clearly, there have been contrasting results with PremPro, and the authors of the WHI trial have even alluded that the results may have been different with HIH. The bottom line conclusion is that continued clinical research is needed to further prove the benefits of bio-identical hormones in preventing heart disease, stroke, cancer, and Alzheimer's disease in absence of an increased risk of breast cancer. In the interim, however, hormone replacement therapy with bio-identicals continues to help women in many ways, including improvement in quality of life, by treating various symptoms associated with menopause.

Phillip Warner, MD
Paul Hueseman, PharmD

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