Surgettes, Power Surge has welcomed many wonderful guests at our meetings. We've had the opportunity to get answers to the infinite questions about menopause and HRT from our regular Power Surge advisors - physicians, naturopaths, psychologists. These professionals give of their free/leisure time to spend an hour or two with Power Surge. Not only have they guested at the PS meetings, but many of them have taken additional time to regularly monitor our PS folder, providing comfort and invaluable information to many who are unable to attend the live chats. I'd like to take a moment to express my gratitude and sincere appreciation to our medical doctors, Allan Aven, Diane Eisman, Jack Blaloch, Vickie Hufnagel, Anne Wigglesworth, Cheri Quincy, and to Charlotte Libov, author/journalist and heart aficionado. For those of us curious about alternative methods of coping with menopause, we've had the good fortune of sharing a forum with naturopaths, Deborah Moskowitz, Sally Wolfe-Puckett, et al. We've also had the privilege of expressing our innermost feelings, fears, concerns to those excellent psychotherapists, Stephen Day and Caroline Blecherman and have received invaluable feedback. Needless to say, the Women's Interests Conference Room was filled to capacity when I managed to schedule celebrated authors, Gail Sheehy [Silent Passage, Passages, New Passages]. Lonnie Barbach [The Pause], Vickie Hufnagel, M.D. [No More Hysterectomies; No More Menopause] and Letty Cottin Pogrebin [Getting Over Getting Older]. Every morning at about 4 AM, I put on my cyber-rollerblades and skate through the Internet looking for the newest medical information to share with you in these newsletters in the Power Surge Reading Room in Women's Interests on America Online and on the World Wide Web as well. I've connected with some of the above mentioned guests via this fabulous super information highway. Only yesterday, I came across information on the Net about where to order Dr. Judith Reichman's tape of her fabulous PBS show, "Straight Talk About Menopause." Ten minutes didn't pass before I was on the phone to California extending an invitation for Dr. Reichman to guest in Power Surge [fingers crossed]. I'm hoping to have Dr. Reichman join Power Surge some time in early Autumn. Some other celebrated guests, and authors of menopause-related books, Lissa DeAngelis and Molly Siple. Their best-selling new book of gourmet cooking for health during menopause, "Recipes For Change" -- is fascinating and chock-a-block full of valuable information about menopause and how what we eat impacts upon how we feel during this rite of passage. Also, Dr. Susan Rako, author of "Hormone Of Desire," with fascinating revelations about the pros and cons of the much discussed Testosterone. Susun Weed will also join PS to talk about her wonderful book, "Menopausal Years: The Wise Woman." Add to that Linda Ojeda, Ph.D., author of, "Menopause Without Medicine," Carolyn DeMarco, M.D., author of "Take Charge Of Your Body" and Betty Kamen, Ph.D., author of, "Hormone Replacement Therapy: Yes Or No?" It certainly promises to be a fascinating summer :) All in all, it's been a wonderful year for Power Surge. It's grown far beyond anything I ever anticipated when I opened a folder on America Online. The Web site has piqued the interest of many women on the Internet and lured them to AOL in order to participate in the live PS meetings, share their experiences with the Surgettes and participate in the Q & A sessions with the wonderful guests Power Surge offers. Spring into summer is a beautiful time of year, replete with a sense of renewal and hope. I can only continue to encourage you to read, investigate, explore and, thereby, discover new methods in order to make this rite of passage as problem-free as possible. Hopefully, by providing these newsletters and such great guests in our chats, it will provide the knowledge and solutions you require to *Own Your Bodies*. A pleasant journey this summer. Be back in the Fall with more goodies! Dearest INDEX Dearest Intro Meno_Quote DEXA - Bone Density Test For Osteoporosis Menopause Studies NAMS Menopause *FAQ* The Older You Get, The More You Need A Mammogram The Different Faces Of HRT Don't Panic Over Abnormal Pap Smears/Mammograms Premarin: Women Have The Right To Know Books, Articles, TV Specials, Free Samples, Etc. FYI: Health Revelations Checking Your Basic Needs: A Test Power Surge Happenings MENO_QUOTE Eliza Flagg Young, MD, a nineteenth century physician, once said, "Every woman is born a doctor. Men have to study to become one." Although this may be a controversial statement, what isn't controversial is that women tend to be the primary health care providers in most families. In the vast majority of homes women are responsible for watching over the health needs of the children, and by their shopping and cooking, they are responsible for fulfilling the nutritional needs of the family. DEXA - BONE DENSITY TEST FOR OSTEOPOROSIS THE BONE-DENSITY TEST: WHAT'S INVOLVED Standard X rays are not much help in determining bone-mineral density (BMD): You'd have to lose at least 25 percent before an X ray could detect it. The state-of-the-art test is DEXA (dual-energy X ray absorptiometry), with more than 700 machines in the United States. The test, which costs about $200, measures bone at the hip, spine, and/or wrist-_-where most osteoporosis-related fractures occur. The test is not for everyone (for example, it wouldn't show much to someone in her thirties, unless she has significant risk factors, like early menopause or unexplained fractures). NOF guidelines recommend it for women who are taking corticosteroid medications; who've had a cracked or fractured vertebra detected by X ray; who have hyperparathyroidism; or menopausal women considering ERT. DEXA is painless, safe, and quick. Fully clothed, you lie on an examining table as a scanner passes over you. The radiation used is one twentieth that used in a chest X ray, and the test is over in about twenty minutes. A physician then compares your BMD to the peak bone density for two populations: "young normal adult," to show how much bone you may have lost; and your own age group, to indicate where you stand for someone of your age, sex, and size. After nearly five years of NOF lobbying, a bill was recently introduced in Congress that would require Medicare to standardize its coverage of DEXA and other approved methods of diagnosing osteoporosis. The hope is that third-party carriers will follow suit. To find out where you can get a BMD test, call the NOF at 800-464-6700. For more information on calcium sources and supplements, call the Calcium Information Center at 800-321-2681. MENOPAUSE STUDIES Power Surge medical consultant, Dr. Allan Aven, is conducting a study testing a new combination of estrogen and progesterone, using a standard dose of estrogen, but a newer concept of progesterone dosing. The purpose is to eliminate or diminish the problem of bleeding during HRT. In addition to obtaining the study drug [free HRT for one year] at no charge, the subject receives a complete examination, pap smear, mammography, variety of blood tests, pelvic ultrasound and endometrial biopsies, the study pays the subject $500.00 for her participation. If you're in the Chicago area, you can call (847) 253-1070, or E-mail Dr. Allan Aven for more information. A Chicago clinic is seeking women to participate in a study on post- menopause. All expenses are covered, plus the subject is given $300.00 for participating. They are also doing a study on osteoprosis. It's a two to three year study on bone loss. If interested, you can reach them at1-800-3-POWER-5 NORTH AMERICAN MENOPAUSE SOCIETY FAQ The North American Menopause Society Web Site features frequently asked questions (FAQs) such as the ones below. This section is a succinct way to learn about menopause, related diseases, treatment, and terminology. Each month a new list of FAQs will be available to read, save to your hard disk, or print. What is menopause? Menopause represents the end of menstruation, usually diagnosed when a woman has not had a menstrual period for 12 consecutive months, and there is no other obvious biologic or physiologic cause. In the Western world, the majority of women experience a natural menopause between the ages of 45 and 55 -- on average at about age 51 -- but it can occur as early as in a woman's 30s and as late as in her 60s. Menopause is not a disease, but a natural event -- the end of fertility -- resulting from the ovaries slowing down production of two sex hormones: estrogen and progesterone. When the ovaries are removed surgically ("surgical menopause") or when the ovaries are damaged through drugs or x-rays, "induced menopause" results. Menopause is considered to be "premature" when it occurs either naturally or is induced before age 40. What is peri-menopause? The term "perimenopause" includes the time immediately prior to the menopause (when the endocrinological, biological, and clinical features of approaching menopause commence) as well as the first years immediately after menopause. These years bring a variety of changes associated with decreasing estrogen levels. These changes or "symptoms" most often start in a woman's 40s and sometimes in her 30s. Many women are surprised by two things: the age at which menopause-related symptoms can begin, and the range of symptoms. Other terms often used to discuss menopause include "premenopause" (all the reproductive years leading to menopause), "postmenopause" (all the time beyond menopause), and "climacteric" (the entire epoch beginning when ovaries start to fail and continuing throughout life -- a term that should be abandoned to avoid confusion). What are typical peri-menopause changes? Before menstruation stops completely, most women experience noticeable changes in their periods. Some periods become shorter in length; others become longer. The flow may be lighter or heavier -- and some women have extensive bleeding with clots. The time between periods often changes, with irregularity being very common. Another change often experienced is the hot "flash" or "flush" -- an uncomfortable warm feeling and increased pulse rate often triggered by being too hot, eating hot or spicy foods, hot drinks, alcohol, caffeine, or stress. There is usually a consistent pattern for a woman's hot flashes; however, each woman's pattern is different. Some hot flashes are easy to ignore, others are embarrassing, still others can be debilitating. When hot flashes occur along with drenching perspiration while sleeping, they are called "night sweats." Since they interfere with sleep, women who have them become tired and sometimes irritable. Healthy sleep patterns are also disrupted by falling estrogen levels. Other changes associated with menopause can include mood changes, forgetfulness, difficulty concentrating, dryness of the vagina, discomfort with intercourse, and lowered sex drive. These are normal reactions to the body's withdrawal from sex hormones. Aging changes which may or may not be related to menopause include incontinence (involuntary leaking of urine), heart disease, and osteoporosis (thinning of bones). A woman's risk for developing the more serious problems should be determined as early as possible. Each woman's menopause experience is different, and most women have minimal symptoms. Indeed, the majority continue to function well. Another piece of good news is that, for most women, the symptoms do not last forever. Most or all diminish or disappear over time, many can be reduced with certain lifestyle changes such as exercise and diet modifications, and most or all decrease or disappear with treatment. For some women, menopause brings a sense of freedom since the end of fertility means no more birth control and dealing with periods. Menopause is a bridge to a part of life when most women report feeling more confident, empowered, involved, and energized than in their younger years. For some women, however, menopause -- coupled with midlife psychosocial crises -- can contribute to serious health problems. So menopause is a signal to continue, or start, a good health program. What is a "vasomotor" symptom? Through perimenopause, the most common changes (experienced by as much as two-thirds of women) are called "vasomotor" -- meaning that they result from a change of the circulation (such as increased blood flow, temperature, and heart rate) and manifest as a hot flash or flush. A woman having a hot flash becomes very warm and may perspire; a cold chill often follows. Hot flashes present no inherent health hazard, but they can certainly be annoying, and are sometimes even debilitating. The usual underlying cause of hot flashes is low levels of the hormone estrogen. Women who are obese are less likely to develop hot flashes, since some estrogen is available from fatty tissue; very thin women tend to have more problems. Women who have an "induced" menopause (through surgical removal of their ovaries or when ovaries are damaged through certain drugs or x-rays), as well as women who have an "early" natural menopause (before age 40) usually have a sudden onset of vasomotor symptoms; they may also be at greater risk for health problems later in life since they will spend more years without the protective effect of estrogen. Is there any way to predict when I will go through menopause? Family history might provide clues, since the time of menopause is determined genetically; however, recalled dates of a mother's or grandmother's menopause may not be accurate. Contrary to previous opinion, there is no correlation between the time of a woman's first period and her age at menopause. In addition, in most studies, other factors that have no influence on age at menopause include race, height, the number of children a woman has had, and whether she took oral contraceptives. There is some evidence that a small percentage of women who have had their uterus (but not ovaries) removed -- called a "hysterectomy" -- experience menopause several years earlier than women of the same age without hysterectomy. One factor that definitely influences the age of menopause is cigarette smoking. Smokers, and even former smokers, can experience menopause up to three years earlier than nonsmokers -- providing another reason not to smoke. Although the time of the initial menstrual period ("menarche") is typically experienced at an earlier age than years ago -- probably because of improvements in health, education, nutrition, and living conditions -- the average age at menopause (about 51 in the Western world) has not changed much since ancient times. If I've had a hysterectomy, how will I know if I've gone through menopause? Following "hysterectomy" (the surgical removal of the uterus or womb, but not the ovaries), there will be no more menstrual periods. Therefore, a woman will not have the best marker for identifying menopause: stopping of menstrual periods for 12 consecutive months. However, with the ovaries still intact, estrogen will continue to be produced so that signs of approaching menopause that may appear include the same ones that could appear with a uterus: hot flashes and night sweats. These changes may continue to be experienced or even worsen when the ovaries shut down their production of estrogen at menopause. Because thermal abnormalities that could be construed as hot flashes are a symptom of some diseases (thyroid problems and some cancers), their cause should be documented. A simple blood test to measure circulating follicle-stimulating hormone (FSH) levels may be helpful. As the ovaries lose the ability to produce estrogen, the pituitary gland increases production of other hormones (called "gonadotropins") to stimulate the ovary to do better. One stimulating hormone is FSH. It is generally accepted that a woman has reached menopause when her FSH blood level rises above 30 to 40 MIU/ml (depending on the testing laboratory). Estrogen (as estradiol or estrone) is also sometimes measured, but obtaining a reliable diagnosis of menopause may be difficult by measuring estrogen alone. Unfortunately, sometimes the term "hysterectomy" is used incorrectly to mean removal or the ovaries as well as the uterus. The correct term for removal of the ovaries is "oophorectomy" or "ovariectomy" -- with "bilateral" oophorectomy meaning that both of the ovaries were removed. When the ovaries are removed, "surgical menopause" results, creating an abrupt decline in ovarian hormones such as estrogen; women who undergo surgical menopause can expect to have severe hot flashes immediately after surgery. If only one ovary has been removed, the remaining ovary may continue to produce a normal level of hormones, preventing immediate menopause. Following hysterectomy, a woman who wishes to take estrogen for menopause-related changes does not need to take another hormone -- progestin -- to guard against an increased risk of uterine cancer that could result from estrogen alone. Therefore, menopause treatment following removal of the uterus is greatly simplified. If I have had a hysterectomy (removal of the uterus), should I still have a Pap test? The Pap test is the primary method for detecting cervical cancer and, importantly, conditions that could develop into cancer if not addressed. The current clinical guidelines recommend that all women over 18 -- or when starting sexual activity -- should have a pelvic exam and Pap test every year. If your tests show abnormalities or if you have had cancer, you may need to be tested more often. It's especially important to have an annual Pap test if you smoke cigarettes, if you are not in a mutually monogamous relationship (if you or your sexual partner have more than one sexual partner), if you have had genital warts, or if you have HIV infection. If you have none of these risk factors for developing cervical changes -- and have three consecutive normal tests -- your healthcare provider may recommend that you be tested less often than annually. An annual pelvic exam is still recommended, however. Following hysterectomy, although the uterus has been removed, the tissues making up the "cervix" (entrance to the uterus) may still be present, although this is rare. Even if the cervix has been removed during the hysterectomy (as is commonly the case), the Pap test of the cells in the vagina is still important to help determine estrogen status and whether any vaginal abnormalities or cancers are present. ERT, HRT, estrogen, progestin, progesterone -- I'm confused. Please clarify hormone replacement therapy for the menopause. Hormones produced in the body include the "sex hormones" estrogen, progesterone, and testosterone. When a woman passes through menopause -- either naturally or induced by surgery, drugs, or radiation -- hormone levels fall, leading to potential problems of hot flashes, night sweats, dry vagina, incontinence, and decreased interest in sex, as well as increased risk of heart disease and osteoporosis. Hormone therapy is then typically considered to provide help. When estrogen is given, that is called "estrogen replacement therapy" (or ERT for short). However, the amount of estrogen medication prescribed is not enough to be truly "replacement"; in fact, it is only a small fraction of the amount of estrogen that the ovary usually produces. When the uterus is present, the natural progesterone that the body once produced must be replaced, sometimes with progesterone vaginal suppositories or (in some countries outside the U.S.) progesterone tablets, but most often with tablets of "progestin" (a synthetic progesterone). Adding progesterone or progestin prevents any increase in the risk of uterine cancer from estrogen. When progesterone or progestin is added to estrogen, that is called "hormone replacement therapy" (or HRT for short). Unfortunately ERT and HRT are sometimes incorrectly used interchangeably -- by the media as well as by healthcare providers -- contributing to the confusion. Why must I suffer the return of a period while taking HRT? HRT (hormone replacement therapy with estrogen and another hormone, progestin) is prescribed to provide help (with estrogen) for menopause-related changes and protection (with progestin) from a potential uterine cancer increased risk that could result from taking "unopposed estrogen" (estrogen alone). Progestin provides this protection by keeping the endometrium (lining of the uterus) from becoming thick and initiating cancer (sometimes called endometrial cancer). With some women, and some dosage regimens, the lining sloughs off and out of the uterus through the vagina. This uterine bleeding is often referred to as a "period" but it is not exactly the same. For example, with HRT-induced uterine bleeding, neither cramps nor bloating are experienced, and fertility is not restored. This bleeding is a nuisance and may be unacceptable, even though for some women bleeding often lessens or stops completely over time. But it's a visible sign that the risk of developing uterine (endometrial) cancer has been reduced to the level of taking no hormones at all. For many women, whether to tolerate it in exchange for relief of hot flashes and other changes associated with menopause is a difficult decision to make. To avoid the bleeding episodes -- but still protect the uterus -- clinicians vary the way that estrogen and progestin are taken. For example, taking both hormones every day (called "continuous combined therapy") may produce less bleeding for some women than taking estrogen and progestin only some days each month and being drug-free on others (various regimens called "cyclic combined" or "cyclic sequential"). However, the continuous combined plan does not work for all women, and it causes spotting in up to 40% of women for the first three to six months, especially in women just past menopause. At any age, women are advised to report any unusual uterine bleeding to their healthcare providers. It's especially important that any postmenopausal (past menopause) uterine bleeding be reported to a clinician. Regular, hormone-induced bleeding is usually no cause for concern; however, bleeding that is unusually heavy, with passing of clots -- or bleeding that occurs at unscheduled, unplanned times -- may be more significant and should be evaluated. This may require an endometrial biopsy (microscopic exam of tissue taken from inside the uterus). There appears to be only one clear benefit from taking progestin: protection against an increased risk of cancer of the uterus. There may be a number of disadvantages: progestin causes fluid retention, headache, breast tenderness, and may possibly affect mood. HDL (good cholesterol) increases less with progestin plus estrogen than when on estrogen alone; however, LDL (bad cholesterol) with progestin plus estrogen is reduced by the same amount as when on estrogen only. Under special circumstances and good supervision, some women take just estrogen alone, but healthcare providers must monitor the uterus of these women very carefully through endometrial biopsy and/or pelvic ultrasound. These tests are expensive; in addition, biopsy is invasive and may be painful during or after the procedure. Note that a woman who has had a hysterectomy (removal of the uterus) has no need to take progestin. I have fibroid tumors inside my uterus. Must I have a hysterectomy prior to beginning estrogen therapy for menopause? Fibroid tumors are "benign" (not cancerous) growths that should be treated according to the usual general medical principles. If they are so problematic that surgery is advised to remove them, it is best to have the surgery before starting estrogen replacement therapy. Usual doses of estrogen rarely cause growth of fibroid tumors. However, large doses of estrogen may cause fibroids to grow, and they could grow to such a size that a hysterectomy would be required to remove them along with the rest of the uterus. You can visit the NAMS' Web site by clicking here: North American Menopause Society Contents © 1996, The North American Menopause Society. All rights reserved LOW-FAT DIET LOWERS LEVELS OF CANCER-CAUSING HORMONES Women who eat a low-fat, high-fiber diet can lower their levels of key estrogens that are thought to play an important role in the development of breast cancer, according to a new study. Los Angeles researchers put 12 healthy premenopausal women on a one-month diet that included 15 to 25 grams of fiber per day and derived 30 percent of its calories from fat. In the following two months, the women ate more fiber (25 to 35 grams per day) and less fat (10 percent of total calories). By the end of the study, the women's blood levels of estrone and estradiol two types of estrogen decreased by 19 percent and 25 percent, respectively, said lead study author Dilprit Bagga of the University of California School of Medicine in Los Angeles. And contrary to previous studies, lowering the women's estrogen levels did not cause any major disturbances in the women's menstrual cycles, Bagga said. The research builds on previous studies focusing on breast cancer and nutrition in different countries, according to the California researcher. For instance, Asian women, who generally eat low-fat, high-fiber diets, tend to have relatively low estrogen levels as well as a low rate of breast cancer. In contrast, white women who have a higher rate of breast cancer than Asian women also have been shown to have increased levels of estrogens in their blood. The researchers urged women to change their dietary habits before menopause, as breast cancer can progress over a 10- to 15-year time period, they reported in the Dec. 15 issue of the journal Cancer. Most breast cancers occur in women over age 50. Increased fat could contribute to breast-cancer risk by raising the amount of estrogen produced in the body, while dietary fiber may lower breast-cancer risk by changing the way estrogen is used in the body and by reducing the amount of fat that is absorbed, the researchers suggested. In the study, the fiber in the women's diets came mainly from whole-grain cereals and vegetables such as peas and beans. ``There is no question that estrogens play an important role in breast cancer,'' said Kenneth Carroll, director of the Center for Human Nutrition at the University of Western Ontario in London, Ontario, Canada. ``Animal research has shown that high-fat diets lead to increased risk of mammary [breast-gland] cancers, and I think humans are probably not too different.'' But he cautioned that women should not be encouraged to eat a diet in which only 10 percent of total calories come from fat. ``That's just not practical,'' he said. ``This study should help emphasize that current dietary guidelines that recommend less than 30 percent of calories from fat should be followed.'' Carroll also stressed that such diets should be started early in life, because that probably is when most breast cancers start. ``That's when the breast is developing, and cells are dividing more rapidly,'' he explained, possibly making them more vulnerable to the growth of cancer. By Jason Kahn THE OLDER YOU GET, THE MORE YOU NEED A MAMMOGRAM "I've lived this long without getting breast cancer. Why should I bother with a mammogram?" A woman's risk of developing breast cancer increases as she gets older. Over three-fourths of the breast cancers diagnosed each year occur in women over age 50. A woman of 70 is almost twice as likely to develop breast cancer in the next year as a woman aged 50. Chances are that you don't have breast cancer, so give yourself a present - the peace of mind that comes with knowing you don't. Have a mammogram - a simple breast x-ray - this year and every year. "But no one in my family has ever had breast cancer." While it's true that a woman's risk is greater if her mother, grandmother, or sister has had breast cancer, more than 80% of breast cancers are diagnosed in women who have no history of it in their family. "If I'm going to get breast cancer, there's nothing I can do about it." Yes, there is. We still don't know what causes breast cancer, but we do know what can improve a woman's chances for beating this disease: early detection. When breast cancer is found early, a woman increases her chances for successful treatment. A mammogram can detect a tumor much earlier than you could feel it. If a lump is found early, while it's still small and before any symptoms appear, a woman has more options for treatment. Surgery often can be limited to just removing the lump and a small amount of breast tissue. Early detection means that a woman's chances for saving her breast are better, and the treatment her doctor recommends will almost always have fewer side effects. "My doctor never told me to get a mammogram." When all is said and done, each of us is responsible for our own health. If your doctor hasn't mentioned the need for a mammogram, ask about it yourself. Women, especially older women, should insist on getting the health care they deserve. If you ask where you can get a mammogram, your doctor will probably be very helpful. You can also get a mammogram by contacting a hospital or clinic or by participating in a special program offered in your community. The American Cancer Society can tell you where you can get a high-quality mammogram that will be looked at by an expert. Just call 1-800-ACS-2345. The American Cancer Society is only one of many respected health and medical organizations that recommend annual mammograms for women age 50 and over. "These kinds of special tests are too expensive. How can I afford a mammogram?" Since l99l, Medicare pays up to $55 for a mammogram every other year for a woman 65 and older. Your American Cancer Society can give you the details. Just call 1-800-ACS-2345. Most states now make insurance companies cover mammograms, too. Some low-cost mammography programs are also available. These are often held during Breast Cancer Awareness Month every October. Some doctors, hospitals, or clinics also may lower their fees for women who cannot afford the usual charge. Check with the American Cancer Society about special low-cost opportunities for mammography in your community. "I don't know where to get a mammogram." If you have a doctor, ask him or her where you can get a mammogram. Many public health departments, hospitals, and women's clinics offer mammography. To get help in finding a place to get a quality mammogram, call your American Cancer Society at 1-800-ACS-2345. "Mammograms are x-rays. Are they safe?" Over the past 20 years, mammography techniques and equipment have improved a great deal, and today the level of radiation is very low and not harmful. "What is it like to get a mammogram? Does it hurt? Is it embarrassing?" When you get a mammogram, you stand beside the machine, and a specially trained technologist helps place your breast on a plastic plate. A second piece of plastic is placed on top and for a few seconds, some pressure is applied to flatten the breast and get a good, clear picture. Two pictures usually are taken of each breast. Some women may feel a little discomfort, but most report none. The entire mammography exam takes about 15 minutes. It's a good idea to wear a blouse with a skirt or slacks, rather than a dress, since you will have to undress above the waist. You probably will be given a short gown to wear during the exam. A specialist, called a radiologist, will read the mammogram to see if any suspicious areas exist. "What happens if they find something?" If a mass is found, the doctor may use a thin needle to remove fluid or a small amount of tissue. This may show whether it's a fluid-filled cyst, which is not cancer, or a solid mass, which may or may not be cancer. Sometimes the doctor will do a biopsy, which is a minor operation to take out part or all of the suspicious tissue. It is then examined under a microscope by a specialist called a pathologist. A biopsy is the only sure way to know whether cancer is present. It's important to remember that even if you are told to get a biopsy, more than 80% of lumps or suspicious areas are not cancer. If the biopsy shows that there is cancer, the woman and her doctor will discuss treatment options. Early cancer often can be treated by removing the lump or a portion of the breast rather than the whole breast. "What if I find something that worries me?" If you find a lump, notice a discharge from your nipple, see any 'dimpling' or puckering of the skin, or notice anything that you know is unusual for you, see your doctor right away. It probably isn't cancer, but do yourself a favor and have it checked out. Some Important Reasons to Get a Mammogram Finding breast cancer early can save your life. As you get older, your risk for breast cancer increases. Three-fourths of all breast cancers occur in women over 50. Most women diagnosed with breast cancer have no history of it in their family. Early detection often means less surgery. The American Cancer Society and 11 other major national medical organizations urge women over age 50 to get mammograms every year. Getting a mammogram is easier than you think. Having a mammogram once a year helps give you peace of mind. American Cancer Society Guidelines For Breast Cancer Detection Breast Self-Exam If you are 20 or over - every month Clinical Breast Exam If you are 20 to 40 - every three years If you are 40 or over - every year Mammography for women who don't have symptoms* If you are 40 to 49 - every one to two years If you are 50 or over - every year Screening mammogram by age 40 For answers to your questions about breast cancer, call toll-free 1-800-ACS-2345. You should begin to get mammograms by the time you are 40. Its especially important to get a mammogram every year starting at age 50. Finding breast cancer early can save your life. This document was created by NYSERNet, Inc. through a grant funded by the New York State Science and Technology Foundation as part of the Breast Cancer Information Clearinghouse For more information on breast health, breast cancer and quality mammography, contact: The National Cancer Institute's Cancer Information Service (CIS) 1-800-4-CANCER. The American Cancer Society 1-800-ACS-2345. The Y-ME Hotline 1-800-221-2141. National Alliance of Breast Cancer Organizations (NABCO) 1-800-719-9154. These calls are confidential. THE DIFFERENT FACES OF HRT If you decide to go on hormone replacement therapy, there are some things you need to know, says Brian Walsh, M.D., director of the Menopause Clinic at Brigham and Women's Hospital in Boston. First of all, not all HRT prescriptions are the same. There are different timetables for taking the formulations, which can come as a cream, patch or a pill. One type of HRT is what doctors call sequential therapy. Estrogen is taken every day for two weeks. Then, on the 15th day, progestin is taken as well. Both estrogen and progestin are continued from day 15 through day 25, and then both are withdrawn. It's at this time that menstruation-like bleeding begins. The dose of each hormone used varies from physician to physician, but the standard dose is 0.625 milligrams of estrogen (Premarin) and 10 milligrams of progestin (Provera). Another method is continuous therapy. Just as implied by the name, both estrogen and progestin are taken every day. This method was developed as a means to eliminate the bleeding that occurs with sequential therapy and it's currently the most common regimen used. Initially, women on continuous therapy do experience irregular bleeding. In time, the bleeding will cease, but that can take up to six months. This therapy usually involves 0.625 milligrams of estrogen (Premarin) and 2.5 milligrams of progestin (Provera). Estrogen creams are often used by women who are having trouble with vaginal dryness. The cream is inserted with an applicator directly into the vagina, where it works to replenish vaginal tissue. Two types of estrogen cream are Dienestrol and Premarin. In the beginning, vaginal estrogen cream is used three to four times a week, until vaginal symptoms improve. Then it's used less frequently. Estrogen patches are often the choice of women who want to take HRT but can't take estrogen orally because of gall bladder disease. The patch, called Estraderm, is the size of a small bandage and is worn on the lower abdomen. The estrogen is absorbed through the skin and then released directly into the blood stream in timed sequence. Estrogen pills are taken by mouth, according to the regimen set by your doctor. Premarin, the most commonly used pill, is a natural form of estrogen - mare's estrogen - whereas some other estrogen pills are synthetic. How effective HRT is in figthing heart disease depends on which type of estrogen you use, according to Dr. Walsh. Estrogen creams and the patch are not as effective as pills. With the pill, estrogen passes through the digestive tract and liver, where it exerts its impact on cholesterol. With the poatch and cream, however, estrogen goes directly into the bloodstream, and the effect on cholesterol is diminished. Source: Excerpted from Total Health For Women, Ellen Michaud, Eliswabeth Torg. NYC, NY: Rodale Press, Inc. 1995 DON'T PANIC OVER AN ABNORMAL PAP SMEAR OR MAMMOGRAM By Dr. George Wilbanks c.1996 Medical Tribune News Service What do you do if your cancer-screening test comes back positive? If the results of your Pap smear, a screening tool for cervical cancer, come back ``abnormal,'' don't panic. Only a very small number of women with abnormal results have invasive cancer of the cervix. In some cases, an abnormal Pap smear can indicate dysplasia, a non-cancerous condition that occurs when normal cells on the surface of the cervix are replaced by a layer of abnormal cells. Dysplasia can be ranked from mild to moderate to severe. The next grade of change in cells is called carcinoma in situ. This is not an invasive form of cancer, but your doctor will do further tests. These may include a repeat Pap test, or an exam in the doctor's office called a colposcopy, during which the cervix is examined through a special magnifying telescope. The doctor also may do a cervical biopsy, in which a small amount of cervical tissue is removed for further study. Treatment of any non-cancerous cervical disorder can range from antibiotics for minor conditions to various surgical techniques that remove abnormal cells. Even if invasive cancer is discovered, the good news is that the survival rate for cervical cancer has increased dramatically in the last 40 years to as high as 85 percent to 90 percent for early-stage cancer. If your mammogram identifies a breast lump, remember that about four out of five breast lumps are benign (non-cancerous). Even if breast cancer is detected, the chances of survival are good when detection occurs early. And today, many women who develop breast cancer do not have to have a breast removed. You may need another mammogram, if the results of the first test were not clear. Your doctor also may order an ultrasound to provide a different view of your breast. Other tests may include needle aspiration, in which a needle is inserted into the lump to learn more about the fluid or tissue involved, or biopsy, in which a small incision is made in the breast to remove the entire lump for further study. A non-cancerous breast condition may go away on its own - or can be treated with drugs or minor surgery. If breast cancer is found, treatment will depend on the size and location of the tumor, and how much the cancer may have spread. Just remember that initial tests results are only a preliminary step. Dr. Wilbanks is president of the American College of Obstetricians and Gynecologists. PETA - PREMARIN: WE HAVE THE RIGHT TO KNOW Premarin is under attack because of the risk of breast cancer associated with taking it, and because of what activists call "the appalling cruelty to mares and the slaughter of their foals" involved in its production. Premarin, made by Wyeth-Ayerst Laboratories, is the only ERT drug made from animal waste. Other drug companies produce ERT drugs from plant sources, which more closely mimic the estrogens in the human ovary. In a study released last summer, Dr. Phillip Warner of the Menopause Institute of Northern California reported that 66 percent of responding physicians have patients who complain of side effects from taking Premarin. Each year, 75,000 mares are impregnated and tied in stalls so small they cannot turn around, take even a few steps, or comfortably lie down. Irritating rubber sacks are strapped around the mares' groins so their urine (known as PMU, or pregnant mares' urine) can be collected to make Premarin. The mares are denied free access to water so their urine will yield a more concentrated estrogen. The foals resulting from these pregnancies are considered unwanted industry "byproducts"--most are slaughtered. "Women have a right to know the dangers associated with ERT and the cruelty involved in Premarin production," says PETA's Dr. Jean Rodgers. "Women and their physicians can opt not to use a drug cruelly derived from pregnant mares when great alternatives exist." Consumers may obtain more information about Premarin by calling the PETA hotline, 1-800-KNOW-PMU. MORE POWER SURGE RECOMMENDATIONS: BOOKS, ARTICLES, STUDIES, TV SPECIALS, FREE SAMPLES, ETC. Note: Power Surge Newsletters share books and information on a whole host of subjects related to menopause, midlife and their endemic issues. Since the Web site's update, you can now locate most of these books in the Power Surge Bookstore MENOPAUSE, WOMEN'S HEALTH, MIDLIFE Dr. Susan Love's Breast Book. Susan M. Love, MD. Reading, PA: Addison-Wesley Publishing Company, 1990. Hormone Replacement Therapy, Yes or No? Betty Kamen, PhD. Novato, CA: Nutrition Encounter, Inc., 1993. (Available from Nutrition Encounter, Inc., P.O. Box 5847, Novato, CA 94948 for $12.95.) Take Charge of Your Body.Carolyn DeMarco, M.D. Winlaw, British Columbia: The Well Women Press, 1994. Total Health For Women. Ellen Michaud, Elisabeth Torg, PA: Rodale Press, Inc., 1995. No More Menopause. Vicki Hufnagel, MD. New York, NY: Plume, 1996. Menopause Without Medicine: Linda Ojeda, Ph.D, Alameda, CA: Hunter House, 1995. Fibroid Tumors and Endometriosis: A Self Help Program. Susan M. Lark, MD. Los Altos, CA: Westchester Publishing Company, 1993. The Pause: Positive Approaches to Menopause. Lonnie Barbach. PhD. New York, NY: Dutton Books, 1993. Getting Over Getting Older, Letty Cottin Pogrebin. NYC, NY: 1996 Healthy Healing: An Alternative Healing Reference, 9th ed. Linda G. Rector-Page, ND, PhD. Sonora, CA: Healthy Healing Publishing, 1992. Menopausal Years: The Wise Woman Way. Alternative Approaches For Women 30-50 Susun Weed. Woodstock, NY: Ash Tree Publishing, 1992. Her Blood is Gold: Celebrating the Power of Menstruation. Lara Owen. New York, NY: Harper Collins Publishing, 1993. The Black Women's Health Book: Speaking for Ourselves. Evelyn C. White, ed. Seattle, WA: Seal Press, 1994 Herbal Healing for Women. Rosemary Gladstar. New York, NY: Simon & Schuster, 1993. Misdiagnosis: Woman as a Disease. Karen M. Hicks, ed. Allentown, PA: People's Medical Society, 1994. Natural Progesterone: The Multiple Roles of a Remarkable Hormone. John R. Lee, MD. Sebastopol, CA: BLL Publishing, 1993. (Available from BLL Publishing, P.O. Box 2068, Sebastopol, CA, 95473, for $9.95 + $2.00 shipping.) The Hormone Of Desire:The Truth About Sexuality, Menopause and Testosterone. Susan Rako, M.D. 1996. Without Estrogen: Natural Remedies For Menopause and Beyond. Dee Ito. New York, NY: Carole Southern Books, 1994. Women's Bodies, Women's Wisdom.Christiane Northrup, MD. New York, NY: Bantam Books, 1994. Is It Hot In Here or Is It Me? Gayle Sand. New York, NY: Harper Collins Publishing, 1993. Menopause-A Second Spring: Making a Smooth Transition with Traditional Chinese Medicine. Honora Lee Wolfe. Boulder, CO: Blue Poppy Press, 1992. Menopause, Naturally. Sadja Greenwood, MD. Volcano, CA: Volcano Press, 1984. Super Nutrition for Menopause. Ann Louise Gittleman. New York, NY: Pocket Books, 1993. Recipes For Change. Lissa De Angelis & Molly Siple. New York, NY:Dutton, 1996 BOOKS ON CANCER Breast Cancer: What You Should Know (But May Not Be Told) About Prevention, Diagnosis, and Treatment. Steve Austin, ND and Cathy Hitchcock, MSW. Rocklin, CA: Prima Publishing, 1994. Cancer as a Women's Issue: Scratching the Surface. Midge Stocker, ed. Chicago, IL: Third Side Press, 1991. Beauty and Cancer. Diane Noyes and Peggy Mellody. Available at most bookstores, or to order, call 1-800-275-8188:Taylor Publishing, 1992. Confronting Cancer, Constructing Change: New Perspective on Women and Cancer. Midge Stocker,ed. Chicago, IL: Third Side Press, 1993. Estrogen and Breast Cancer. Carol Ann Rinzler. New York, NY: Macmillan Publishing Company, 1993. BOOKS ON HYSTERECTOMY The Castrated Woman: What Your Doctor Won't Tell You About Hysterectomy. Naomi Miller Stokes. New York, NY: Franklin Watts, 1986. Hysterectomy-Before and After. Winnifred B. Cutler, PhD. New York, NY: Harper and Row, 1988. The Hysterectomy Hoax. Stanley West, MD. New York, NY: Doubleday, 1994. How to Avoid a Hysterectomy. Lynn Payer. New York, NY: Pantheon Books, 1987. No More Hysterectomies. Vicki Hufnagel, MD. New York, NY: Plume, 1989. ARTICLES Hargrove JT, Maxson WS, Wentz AC, Burnett LS. Menopausal hormone replacement therapy with continuous daily oral micronized estradiol and progesterone. Obstetrcs & Gynecology 1989; 73(4):606-12. Ottosson UB, Hohansson BG, vonSchuoultz. Subfractions of high-density lipoprotein cholesterol during estrogen replacement therapy: A comparison between progestogens and natural progesterone. American Journal of Obstetrics and Gynecology 1993; 151(6): 746-50. HEART The Women's Heart Book: The Complete Guide To Keeping Your Heart Healthy. Charlotte Libov, New York, NY: Plume What To Do If Things Go Wrong. Charlotte Libov, New York, NY: Plume 50 Essential Things To Do When The Doctor Says It's Heart Disease. Charlotte Libov. New York, NY: Plume OSTEOPOROSIS Preventing and Reversing Osteoporosis. Alan R. Gaby, MD. Rocklin, CA: Prima Publishing, 1994. Articles Lee JR. Is natural progesterone the missing link in osteoporosis prevention and treatment? Medical Hypotheses 1991. Lee JR. Osteoporosis reversal; the role of progesterone. International Clinical Nutrition Review 1990; 10(3): 384-91. Lee JR. Significance of molecular configuration specificity: the case of progesterone and osteoporosis. Townsend Letter for Doctors 1993; 558-63. Prior JC: Progesterone and its relevance for osteoporosis. Bulletin For Physicians 1993; 2(2): 1. Prior JC, Vigna Y, Alojado N. Progesterone and the prevention of osteoporosis. Canadian Journal of Obstetrics/Gynecology and Women's Health Care 1991; 3(4): 178-184. Prior JC, Vigna YM, Schecter MI, Burgess AE. Spinal bone loss and ovulatory disturbances. New England Journal of Medicine 1990; 323: 1221-7. TELEVISION SPECIALS Straight Talk About Menopause. Judith Reichman, MD. PBS [Public Broadcasting[, 1993. If your area hasn't aired the Dr. Reichman special, you can order the video tape by clicking here Straight Talk About Menopause Video Women's Hearts At Risk: A one hour documentary on women and heart disease. Charlotte Libov. PBS: 1995 You can find out more about Charlotte Libov's work in the area of heart disease by clicking here: Women's Health Hot Line FREE SAMPLES Alacer Products Corp. offers free samples of their health products, such as vitamins, herbs, formulas by calling 1-800-854-0249, or E-mailing Alacer here. Or by visiting their Alacer Corp.Web Site You can get a free copy of the pamphlet ``Alcohol & Women'' by sending a stamped, self-addressed, business-size envelope to: The American College of Obstetricians and Gynecologists, Resource Center/ AP068, 409 12th Street, SW, Washington, DC 20024. FYI: HEALTH REVELATIONS TO PONDER While sojourning across the super information highway, I've collected fascinating data to share with you. The following are some of the health tips uncovered by medical research or suggested by correspondents over the last twelve months, from the Institute for Social Inventions. Although I feel it necessary to invoke my usual disclaimer regarding the accuracy/efficacy of the tips contained herein; nevertheless, they're certainly deserving of consideration in this age of exploration and self-doctoring. Dearest The Power Surge Newsletter disclaims any representation for the accuracy or completeness of information contained herein. It is purely for informational purposes. Health matters should be taken up with one's personal physician. Nothing in the Power Surge Newsletter is intended as a substitute for professional medical advice. In a study of 36 women, Hormone-Replacement Therapy resulted in subtle but significant increases in intelligence and memory, particularly where the task was a complex one. (Dr Halbreich at the State University of New York in Buffalo.) Women on estrogen-replacement therapy may significantly lower their risk of death from colon and rectal cancer. The Wall Street Journal, April 5th '95.) Stretch-material or sports bras with sufficient cleavage can prevent or cure lumpy breasts. It has now been found that benign lumps in the breast called fibroadenoma are predictors for a greater risk of breast cancer later. (Valerie Yule in a letter to the Institute.) The hormones produced through nipple stimulation - two to three minutes twice a week - may help protect against breast cancer. Prof Tim Murrell, Dept of Community Medicine, University of Adelaide.) Women under 45 who have abortions have a 50% higher risk of developing breast cancer, according to an American study involving 1,800 women. No increased risk was associated with spontaneous abortion or miscarriage. In a study of 500 women, exercise averaging four hours a week since menstruation reduced the women's chances of developing breast cancer by almost 60%. (University of Southern California School of Medicine in Los Angeles.) The lipocene pigment in tomatoes may help guard against cancer up to 2 lbs a day could make all the difference. (Professor George Truscott, head of the chemistry department at Keele University.) A study of 5,000 vegetarians found that they had a 40% lower risk of dying of cancer and 20% lower risk of dying of any cause compared to meat eaters. (British Medical Journal.) Alcohol drinkers with 'an empty-calorie diet high in white bread and sweets' had a three times higher incidence of colon cancer. Journal of the National Cancer Institute.) Antioxidant vitamins beta carotene, vitamins C and E) may help prevent obstructive lung disease. Smokers are 1.5 times as likely to suffer impotence, even after removing the effects of other possible causes such as drinking, psychiatric problems, heart and circulation problems. (American Journal of Epidemiology.) The anti-depressant drug, Anafranil, reduced premature ejaculation in a study of 15 men. (The Daily Telegraph Aug 30 '95.) Don't wear bifocals typing on your computer. You will tilt your head to an unnatural angle and put a strain on your neck, leading to painful neck problems. (Teleconnect.) Higher levels of magnesium in the blood - the result of a diet rich in fruit, vegetables and whole grain may help prevent asthma. Dr John Britton, Nottingham City Hospital.) 50 grams of fresh ginger every day can inhibit two of the enzymes responsible for inflammation in arthritis. Odenske University in Denmark.) The higher the consumption of carotenes, the pigment found in green, leafy and yellow vegetables - and particularly the lutein and zeaxanthin carotenes found in dark green leafy vegetables such as spinach, the lower the risk of macular degeneration of the edge and of blindness in old age. (Journal of the American Medical Association.) Those with the equivalent of A levels or university degrees were up to three times less likely to suffer dementia in old age. (British Medical Journal.) Rats that exercised had much higher levels of brain-derived neurotrophic factor - a factor reported to decline with the onset of Alzheimer's. Dr Carl Cotman, University of California.) Zinc may help trigger Alzheimer's although a deficiency can cause slow wound healing, loss of appetite and other problems). In 1992, the University of Melbourne gave zinc supplements to five Alzheimer's patients but within four days their cognitive decay markedly accelerated. (David Steel, The Wall Street Journal, Sept 2nd '94.) Those taking non-steroidal anti-inflammatory drugs such as ibuprofen, indomethacin and even aspirin, are less likely to contract Alzheimer's. Nigel Hawkes, The Times, Feb 6th '95) Aspirin delays the aging of tissue (in the test tube); it damps down virus replication in HIV-infected tissues (in the test tube); taken regularly it may reduce the risk of colorectal cancer; it adds a health-giving boost to red and white wine; and in small doses it blocks thrombosis and protects against strokes and heart disease. (Guardian Aug 17th '94.) Singing helps keep the palate soft and prevents snoring. Snoring often starts once the throat muscles become floppy due to age, lack of exercise or weight gain. (Dr Elizabeth Scott, adviser to the Scottish Chamber Orchestra.) Almonds and walnuts reduce the cholesterol level and may thus help prevent coronary heart disease. (American Journal of Clinical Nutrition.) The life-shortening effects of failing to exercise vigorously are comparable to smoking 20 cigarettes a day. (Study of 17,300 Harvard graduates, report by Nigel Hawkes in The Times.) This information was gathered at a fascinating Web site included among the Power Surge links, The Global Bank CHECKING YOUR BASIC NEEDS:A TEST Those who've attended the Power Surge meetings know that I may suddenly, without warning, invoke the "free association" mode when the participants are engaged in a free-form discussion and no guest is present. I will type out a question on the screen leaving a blank space for the participants to fill in with the first answer which comes to mind. It's always well received. It's fun. It motivates us to think about our lives, to appreciate the good and, at the same time, encourages us to seek support about that with which we feel displeased and sometimes helpless to change. It provides those participating an opportunity to "unload," so to speak, some of their grievances, or "boast" about those things in life which bring them great joy. When, and if, a response surfaces which gives cause for concern, such as, "Life isn't worth living" [this has happened], it opens the door to discourse among the participants, to drawing the confessor out, encouraging her to share her feelings, and general stroking and support by those present at the Power Surge meeting. This is invaluable and what Power Surge is really all about - caring and friendship .. but, most of all, sharing. Therefore, I'd like to present a similar array of questions for you to ponder in your leisure time - questions that will address your lifestyle, desires and give you some insight into whether or not your needs are being met. I've taken some of these questions from a marvelous book I received last Christmas from a dear friend - "The Woman's Comfort Book: A Self Guide To Restoring Balance To Your Life" by Jennifer Louden. Set aside time and space for yourself when you answer these questions. Need: What Is It? A need is something we require for our well-being, like food, sunlight, contact with other humans; our needs should be non-negotiable, things we cannot do without. But sometimes we get so wrapped up in life, in surviving, in getting ahead, in taking care of others, we lose sight of these basic requirements. Don't let that happen! Healthy self-care begins with checking to see if YOU are meeting YOUR basic needs and then working to fulfill them. You can copy and paste this into your text editor, and answer the questions in that mode. You should take this test when you are vaguely dissatisfied, depressed or tense - when you can't remember the last time you got a good night's sleep, relaxed or ate a healthy meal. These mindsets will yield the most accurate answers. What To Do - Checklist: This list will help you create a picture of your lifestyle. Are you satisfied with where you presently are in life? Do you usually get six to eight hours of sleep? Do you eat something fresh and unprocessed every day? Do you allow time in your week to touch nature, no matter how briefly? Do you get enough sunlight, especially in the wintertime? Do you drink enough water? Do you see your gynecologist (or the equivalent) at least once a year? Do you see a dentist every six months? Do you know enough about your body and health needs? Are you currently in a loving relationship with a sexual partner? If you're not currently involved in a relationship, do you yearn for one? If living alone, do you enjoy your own company? What things would you change about if you could? Do you get regular sexual thrills? Do you feel you get enough fun exercise? Do you have friends you can call when you are down, friends who really listen? Do you regularly release your negative emotions? Can you honestly ask for help when you need it? Do you feel the only way something will get done right is if you do it? Do you forgive yourself when you make a mistake? Do you live in the past, or are you making efforts to enjoy the present and plan for the future? Do you do things that give you a sense of fulfillment, joy and purpose? Is there abundant beauty in your life? Do you allow yourself to see beauty and to bring beauty into your home and office? Do you make time for solitude? Are you getting daily or weekly spiritual nourishment? Can you remember the last time you laughed until you cried? Do you accept yourself for who you are? 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. POWER SURGE DISCLAIMER The Power Surge Newsletter disclaims any representation for the accuracy or completeness of information contained herein. The sharing of information herein is not indicative of Power Surge's personal endorsement of same. It is purely for informational purposes. Health matters should be taken up with one's personal physician. Nothing in the Power Surge Newsletter is intended as a substitute for professional medical advice.

Love And Good Health!

OWN YOUR BODY!