In Conjunction With Thrive And AOL
In AOL Live's "Bowl" Auditorium
January 25, 1998
OnlineHost: " Dr. Susan Love's Breast Book changed the way women thought about breast cancer and helped launch a political movement. Now the famous doctor, author, and advocate takes on menopause with "Dr. Susan Love's Hormone Book." Power Surge and Thrive are proud to introduce Dr. Susan Love. LiveOnstge: Hello everyone thank you for joining us in welcoming Dr. Susan Love:) Dearest: Dr. Love, a very warm welcome back to Power Surge and our extended edition tonight in AOL Live's Auditorium. It's a pleasure to have you join us again :) Dearest: Let me begin by asking, are we any less confused about the safety and efficacy of HRT (hormone replacement therapy) today than, say, three years ago? Slovemd: Well, not really maybe even more confused. But the good news is that there is a lot more research going on now and we will have more answers in the near future Dearest: Thank you, Dr. Love. Let's take an audience question :) Comment: What do you think of "Natural Estrogen", such as is recommended in "Estrogen The Natural Way" by Nina Shandler? Is it a good method for protecting bones? Slovemd: Yes, there is a difference between "natural " estrogen that you can get compounded at special pharmacies and "natural" estrogen that you can get in food. The kind that is found in soy for example is not exactly estrogen and is at a very low dose. Nonetheless, it has been shown to be good for the bones, decrease cholesterol and stop or decrease hot flashes. It also has beneficial effects on breast cancer and may well prevent it. All this with no down side. But this is for those women who are looking for prevention. I would not use soy as my only treatment for osteoporosis for example. Dearest: Dr. Love, a member of Power Surge mentioned that she's had breast cysts aspirated about 6-7 times in both breasts over the last 10 years. She wanted to know if someone with that history should take HRT. Lab tests, mammograms, ultrasounds are all okay. Thanks. Slovemd: Breast cysts are fluid filled sacs which occur in the breast of premenopausal women. They do not increase the risk of breast cancer. They also go away completely with menopause unless you take HRT. The question is why you want to take HRT. If it is for relief of the time limited symptoms of menopause then you have to decide whether the symptoms are worse than cysts. Slovemd: If it is for prevention the rest of your life...then you have to decide whether you want to keep having cysts or whether you want to try another form of prevention. Dearest: Thank you, Dr. Love. Let's go to the audience again for a question. Comment: What strength Vivelle patch is equivalent to the .625 mg estrogen to obtain maximum bone protection -- .05 mg or ? Slovemd: This is a good question and we do not really know the answer. Recently we are finally seeing research on how much estrogen you really need to prevent osteoporosis. To many people's surprise a recent study showed that .3 was as good as .625 of Premarin. But I am unaware of data on the patch. It is not exactly the same as a pill because it is not metabolized in the liver. So you can't just take the information on Premarin and translate it directly. Stay tuned ...more info is bound to come out soon. Also a study just last week showed that estrogen without calcium had more less effect on bone density so don't forget the calcium and vitamin D. Dearest: What are your feelings about the new drug, Raloxifene, aka Evista, which is supposed to provide the protection HRT does but not a remedy for the usual menopausal complaints? Slovemd: This is a SERM or selective estrogen receptor modulator (I always remember it as sperm without the p!!). Anyway it is designed to do all the good things and none of the bad As usual it isn't perfect. It will help bone density some but not as much as estrogen. It helps cholesterol some but not as much as Premarin and may not help the blood vessels like Premarin. It does decrease breast cancer in two years of study...but Premarin takes five years to increase breast cancer so two years is not enough. It may not help the brain and worst of all it causes hot flashes and vaginal dryness!!!! Whenever something sounds too good to be true it usually is!! Nonetheless, it is another option which may work for some women. I think the more options we have the better. We just need to remember that there is a pharamceutical company who wants to make lots of money on it. We need to take everything -- even information about estrogen with a grain of salt. Comment: I am a 21 year old female and recently I found a small lump on my breast and I was wondering what I should and if breast cancer is common is women my age. Slovemd: Breast cancer is very rare at your age although not impossible. Lumps at your age are usually fibroadenomas. These are benign outgrowths of tissue which are not harmful. You should get it checked out but I wouldn't worry too much Dearest: Dr. Love, what is the difference between progestin and progesterone? Slovemd: Good question. Progesterone is a hormone which is made by the egg sac in the ovary after we ovulate. It gets the body ready for pregnancy. That is why it is called Pro gest (pregnancy) terone. It is not normally present after menopause because we do not ovulate. Slovemd: Progestin is a synthetic version of the natural hormone which has some of the same effect and some different ones. Both are used to counteract the bad effects of estrogen on the uterus in postmenopausal women. Progesterone is more "natural" (there is that word again) and probably better for you but it is difficult to get and must be compounded specially. Slovemd: Provera is the progestin used in this country and it is effective for the uterus but may block some of the good effects of estrogen. I might add one of the benefits of Raloxifene that we mentioned earlier is that it does not stimulate the uterus as estrogen does and so you do not have to take a progestin or progesterone with it. Dearest: Thanks so much for that very comprehensive answer, Dr. Love. Let's go to the audience.. Comment: What ar your true feelings about estratest? What would you use instead of this drug? Slovemd: I am worried about the use of testosterone. We have very little data on it. It depends what you are using it for. The main argument in its favor is libido for those women especially who had a hysterectomy and have no libido. The dose needed is much less than that in estratest. I think we need to research how little you can take and still get an effect. Dearest: Re testosterone therapy, Dr. Love... is it true that women can develop heart disease from taking testosterone therapy? Slovemd: God only knows and she only talks to me once a week! Dearest: LOL! Slovemd: Actually there has been a little data from monkeys showing that cholesterol doesn't go up. But it is known to be a factor in heart disease in men so the jury is still out! Comment: Is there ever a safe time to take HRT if you have had breast cancer? Slovemd: I personally do not think so. It is interesting that all of the risk factors for breast cancer have to do with estrogen and all the treatments work to decrease estrogen. There is always the possiblitiy of cells lying dormant and I would hate to wake them up with estrogen Dearest: Dr. Love, when talking about hormones, we hear a great deal these days about receptors or SERMS. Can you simplify what SERMS are and how they work? Slovemd: This all started with Tamoxifen a drug that is used for breast cancer. It blocks estrogen in the breast and so we thought it would block estrogen everywhere only to find out that it actually acted like estrogen in the bones, liver and uterus. This told us that a drug could be like estrogen in some organs and block estrogen in others. The pharmaceutical companies were off and running to design the perfect SERM and Raloxifene that we spoke about is the first. But life is not so simple. Slovemd: Turns out that there are actually two estrogen receptors not one as we had always thought. Some drugs like Raloxifene or tamoxifen can block one and stimulate the other. The reason that this all seems confusing is that even the scientists are confused now. Slovemd: This is really a work in progress and all I can say is stay tuned. The answer will come eventually! The good news is that at least we are finally doing the research to get the answer. Excuse me while I have my hot flash... Dearest: Dr. Love, this may be a little different from the type of question you're accustomed to, but I'm sure many women are interested -- how is menopause treating YOU, and how are YOU treating menopause? :) Slovemd: I wasn't kidding a minute ago ...I am having a hot flash even as I type I am two weeks from fifty and in the throes of perimenopause. I take vitamin E, multivitamins and eat some soy every day. In addition, I am exercising five times a week and trying to watch my diet. So far so good. I am not suffering enough to take drugs yet. Slovemd: But I would not rule them out. If it gets too bad I would take Premarin for three to five years and taper off gradually over 6-9 months. I don't think I will take it for prevention however, i would rather look to my lifestyle. I also think you have to laugh a lot and I have decided that chocolate is a vegetable!!!! Since it comes from a bean...so I try to eat some every day! Dearest: Why Premarin? Slovemd: Because we know the most about it. Comment: Interested in information about the effects of Tamoxifen on the liver. I had breast cancer and am now taking Tamoxifen. Slovemd: Tamoxifen has been shown to cause liver cancer in rats but as of yet not in women. It does cause uterine cancer (1 in 1000) so if you have any bleeding check it out. Tamoxifen taken for five years will decrease both the recurrence of breast cancer as well as the chance of getting it in the other breast. It is worth taking for five years. After five years the cells become resistant and it can actually increase breast cancer. Dearest: Dr. Love, are we deluding ourselves about natural products, i.e., thinking even natural progesterone creams made from wild yam extract are natural when they have to go thru laboratory processing, too? Slovemd: I think everyone is using the word natural to serve their own purpose. "Natural " estrogens that are compounded have the same problems as Premarin does. They can promote breast cancer and uterine cancer. You have to decide first whether you want to take hormones for symptoms or prevention and the then decide which flavor you want to take ie the pregnant mare's urine flavor or the wild yam flavor. but we are deluding ourselves if we think that just because it started out in a Yam and then was made into a hormone it is safer. Dearest: Thanks, Dr. Love. Time has flown, unfortunately, so let's take one last question from the audience. Comment: There are many people who do not want to take HRT like myself. I am using soy products especialy soybeans so far so good your comments please I have controlled high blood pressure and varicose veins and do not want HRT. Slovemd: I think soy products are a miracle food. They prevent high cholesterol, increase bone density , decrease breast cancer, decrease hot flashes and decrease prostate cancer. I haven't found a downside . I eat a lot of soy myself. I have even found a way to make a wonderful tofu chocolate pudding so that I can eat my soy and my vegetables together. -------------------- Dearest note: As a special treat to you readers out there, I'm including the referenced Tofu Chocolate Pudding recipe originally found in Nina Shandler's wonderful book, "Estrogen, The Natural Way" and posted on the Power Surge Message Boards (keyword: Powersurge@thrive) by Surgette, Carol (Kaaitjie) Tofu Chocolate Pudding Recipe Yields 4 servings (except for some of us) :) Takes five minutes to prepare Takes one minute to eat 9 oz.silken tofu 1/2 cup unsweetened cocoa powder 1/4 cup maple syrup ( can substitute with corn syrup) 1 tablespoon blackstrap unsulphured molasses 1 tablespoon vanilla extract. Place all ingredients in food processor and process until smooth and creamy. Taste. Add more vanilla if needed. Serve or refrigerate. Some plant estrogen or calcium will be lost if you omit the maple syrup. ---------------------- Dearest: Dr. Love, thanks for joining us again in Power Surge and so excellently fielding our many questions about menopause and hormones. Dearest: I strongly recommend "Dr. Susan Love's Hormone Book" and "Dr. Susan Love's Breast Book" (Random House) for every woman. If you're considering E-Mailing Dr. Love here on AOL, she asked that I mention that she regrets she doesn't check her AOL E-Mail on a regular basis. LiveOnstge: Dr. Love, thanks so much on behalf on Thrive, Power Surge and Dearest -- another great forum! Good Night. Dearest: Thanks, Dr. Love, for joining us in Power Surge. I look forward to your return again in the very near future. Slovemd: My pleasure. I would love to come back Dearest: You have an open invitation, Susan :) Copyright 1998 Power Surge™ All Rights Reserved Copyright 1998 America Online, Inc. All Rights Reserved. End of Dr. Susan Love log - 1/25/98 Dearest aka Alice Stamm Power Surge Founder, Host, Facilitator E-mail Dearest Copyright©1994-1998 by Power Surge. All Rights Reserved.