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Dr. Marcie Richardson  


Power Surge Live!
Host: Dearest
Guest: Marcie Richardson, M.D.

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Dr. Marcie Richardson

Dearest: Tonight's guest in Power Surge is Dr. Marcie Richardson, OB-Gynecologist. Marcie has been in private practice in Massachusetts since 1979 and is on the advisory board of the Harvard Woman's Health Watch. Tonight Marcie will field our questions about menopause. Welcome to Power Surge, Dr. Richardson. Dr. Marcie Richardson: I am a gynecologist, 47 and definitely perimenopausal, so I am trying to figure this out too. Kromeriz: Can you tell us what you brought home from the North American Menopause Society (NAMS) meeting? Dr. Marcie Richardson: If you want to know what I learned it is that we do not know whether women should be on HRT. Dearest: Marcie, I was wondering what the biggest complaint you hear from women in perimenopause or menopause? Dr. Marcie Richardson: Women feel out of control of their emotions and their bodies. BBatestric: Are panic attacks associated with menopause in any way? Dr. Marcie Richardson: This is an area I am more and more interested in, how changing hormones affect the brain and mood. I see a lot of women who experience panic attacks in these years. Linda Lou5: I am perimenopausal with regular periods and I do not use hormones. Some cycles are okay with regard to PMS, but others I am nuts. Do you have any suggestions for dealing with this? Dr. Marcie Richardson: I think PMS often gets worse in the perimenopause. Birth control pills help if you don't smoke. Exercise has been proven to improve PMS. Some people at NAMS were using low dose hormones. Some new data suggests low dose Prozac. I vote for exercise first. Linda Lou5: My doctor will not prescribe Prozac. Dr. Marcie Richardson: Find a doctor who will prescribe Prozac if you feel that badly. SStot: Why not use HRT or some natural form like progesterone skin cream? Dr. Marcie Richardson: I have to learn more about progesterone creams. They are absorbed inconsistently. There was a group at NAMS who likes them a lot. GRANIA3217: Is there any recent information within the last year regarding HRT that combines estrogen and testosterone (i. e. Estratest)? Dr. Marcie Richardson: That is an interesting question. The data is very limited. I have some patients who feel much better on estrogen and testosterone, but no one knows the long term effects. WRasmus306: My wife has been troubled by what we read to be hot flashes. Her doctor says no because she can measure the body temperature up to 101+. She has been tested for everything under the sun, and the tests are negative. Is a measurable temperature increase and rapid decrease indicative of a hot flash? Dr. Marcie Richardson: A woman's skin temperature goes up with hot flashes, but I am not sure about her core temperature. I will have to check this out. There are other hormonal indications of perimenopause and she could try some estrogen. GracielaZ: I am 44 and I do not have hot flashes yet, but someone drained my memory. I'm forgetful and absent-minded. Dr. Marcie Richardson: Gracie, one of the tough areas in thinking about menopause is what is hormone-related, what is aging and what is the complexity of our lives. With memory loss, I think it is all of these. FBriggs113: I am worried about osteoporosis. My Mom had breast cancer twice and died of metastatic cancer. What are the pros and cons of HRT? Dr. Marcie Richardson: One of the big areas of uncertainty with HRT concerns the risk of breast cancer, and if that risk is greater in women with a family history. As for osteoporosis, the good news is that avoiding cigarettes, doing weight bearing exercise, and taking vitamin D and calcium can help. You can monitor your bone loss to decide whether you want additional medication like HRT or Cal citonan or fosomex. Postrain: Why do some doctors push estrogen while others are concerned about "challenging" with progesterone? Dr. Marcie Richardson: The progesterone challenge test evaluates whether a woman is making estrogen on her own. A woman is given progestin; and if she is making estrogen, she will have a period. Not all doctors use this technique for seeing if a woman needs estrogen. APLPWR: Do you have any information on benefits or side effects of DHEA with regard to menopause? Dr. Marcie Richardson: DHEA is intriguing. Levels of this potent hormone definitely fall as we age, but not much is really known about what this means clinically yet. CAJASS: I will be 38 next month and I am three years into perimenopause. My doctor was hesitant to use hormones because of my age. Does age matter? Dr. Marcie Richardson: We use hormones in young women all the time (birth control pills) and they are stronger than HRT. Yikes0708: I am experiencing panic attacks with perimenopause. Is there help from a medical standpoint? Dr. Marcie Richardson: It is not clear how much hormones are involved with regard to panic attacks in the perimenopausal period. I would consult an experienced mental health clinician first. SStot: What have you heard about the saliva tests for estrogen, progesterone, and testosterone levels? Dr. Marcie Richardson: I am just learning about the saliva tests and I am having a fair amount of trouble finding hard scientific data. They have the advantage of not requiring blood letting, but we do have to know what the results mean, and I think we need to study this more. LdyJane886: Does HRT help guard against heart disease? I take Prempro and do not have periods. Should I? Dr. Marcie Richardson: If you are on Prempro that is continuous, combined therapy you should not have any bleeding after the first few months. Lots of data suggest HRT protects against heart disease, but many of the studies are biased because doctors have put healthier women on HRT. I think we will prove a protective effect with the woman's health initiative. Fehoff: I have had hot flashes for eight months now. How much longer? I cannot have estrogen replacement therapy (HRT) due to breast cancer. Are there any alternatives? Dr. Marcie Richardson: On the average, women have hot flashes for 3-5 years. Some other medications have been tried for hot flashes, but none work as well as estrogen. Dearest: Marcie, I noted in your biography that it says you are now associated with an HMO after leaving your private practice. I am wondering if you'd reassure some of us that we get the same good care using HMO's as we do with private physicians. Dr. Marcie Richardson: I think there is a lot of variety in the health care women get and you are the expert on your body. The HMO, or the doctor, or the nurse or whoever the consultants are, they should collaborate with you. This collaboration depends on the right match not whether it is an HMO or a private doctor. WRasmus306: Does the feeling of uselessness and not being able to keep to a task at hand seem common for menopause? Dr. Marcie Richardson: I think we all feel that way sometimes; but if it comes frequently or you are having trouble sleeping or gaining and losing lots of weight, you may be depressed which is another common problem. Postrain: Why do allergies increase during menopause and perimenopause? Can something be done without using medications? Dr. Marcie Richardson: I am not familiar with increasing allergies as a frequent complaint. Have you allergy-proofed your house? Postrain: Yes, the house does not seem to be the problem and other women in menopause seem to have increased allergies, too. Dearest: Yes! Dr. Marcie Richardson: I'll try to check out this allergy question on my Med line search. CAJASS: My hot flashes have almost disappeared, but now I have incredible cold flashes. Do you have any suggestions for them other than a sweater? Dr. Marcie Richardson: Has your thyroid been tested? CAJASS: No, not recently. MAEFIELD: Have there been any problems with testosterone causing cancer? Dr. Marcie Richardson: I am not aware of any data on testosterone and cancer. The main concern is heart disease and of course hair growth, voice lowering, and aggressiveness. Simp56636: I know mood swing is normal for perimenopause, but what about sexual drive. Is it normal to be high and low during this time? Dr. Marcie Richardson: As Susan Love said, "The most important sex organ is the brain." If your mood is up and down, so goes the libido. GRANIA3217: Would a NAMS membership list be a way to find a local doctor knowledgeable about menopause? Dr. Marcie Richardson: Yes, NAMS has a list of members and most of the members have a special interest in menopause. LdyJane886: Are you against giving HRT? How long should we be on them? I feel so much better on them. Dr. Marcie Richardson: I am not against HRT. I think it is a decision each woman must make after she is fully informed taking into consideration her risks and preferences. I think there are two main reasons for HRT: one is to treat symptoms of estrogen deficiency such as hot flashes and the other is for preventive therapy against osteoporosis and heart disease. Most of the major risks (breast cancer) happen after five years. Maya Moon: What are your views on taking herbals such as Motherwort during menopause? Dr. Marcie Richardson: I wish I knew more about herbs. I wish someone would give us funding to study them. I am sure they can be helpful, but I worry they too have risks. CAJASS: I've been getting severe headaches during sex. Could this be hormonal? I always get headaches before and during my period also. Dr. Marcie Richardson: I think headaches often get worse in the perimenopause with raging hormones. HRT will sometimes help. As for headaches during sex, I am not sure. MAEFIELD: I exercise every day, eat well and I still get very, very depressed. What will help? Dr. Marcie Richardson: You need to consult a mental health clinician and you may need antidepressants. I used to be skeptical, but after they really helped my mother, I am grateful for them. JudithS573: I had a mastectomy in July 1995 and I had one positive node. I also have a strong history of BRCA in my family. I am now considering breast reconstruction. Do you know of any value to a preventive mastectomy? Dr. Marcie Richardson: This is not my area of expertise, but read Sue Love's BREAST BOOK and contact the Breast Cancer Coalition. You should also get a second and third opinion. Dearest: Judith, there are wonderful breast cancer support groups, message folders and chats on-line. If you e-mail me, I'll send you the information. Dearest: Marcie, in regard to your reply to the question about depression earlier, I was surprised that you suggest a mental health person and anti-depressants right off the bat. Wouldn't it be wise to first suggest taking Vitamin B-6 and B complex combined with a regular exercise program? What do you think? Dr. Marcie Richardson: I thought the person said she was exercising and eating well. I guess it also depends how well or poorly someone is functioning. I would always start with exercise. There is a book "WHEN FEELING BAD IS GOOD" about depression that is helpful as well. I think therapy can be very helpful and medications should not be ruled out. WRasmus306: What if a woman is handicapped and cannot exercise as I always see recommended? Dr. Marcie Richardson: That is a good question? Often, there are ways handicapped people can exercise. A physical therapist might be able to help. Some people cannot exercise, I guess. Postrain: How do doctors know when to take a woman off HRT? Would a 90 year old benefit from HRT? Dr. Marcie Richardson: If you are on HRT for symptoms only, most people stop after 3-5 years. If you are taking HRT for prevention, you need at least 7-10 years for a bone effect and some doctors think you should take it forever. We do not have enough experience to really say. CAJASS: Do bladder control and menopause have any connection? Dr. Marcie Richardson: Absolutely, estrogen keeps the uro-genital tract supple. After menopause, incontinence often gets worse. MAEFIELD: In what way can taking birth control pills during peri-menopause help? Dr. Marcie Richardson: Birth control pills can control your cycles and keep your hormones on an even keel as well as providing birth control. WRasmus306: My handicapped friend's legs puffed out greatly in the last 2-3 months. Will the edema go away when the hormones straighten out? Dearest: Is she still menstruating, WR? WRasmus306: No Dr. Marcie Richardson: Her legs puffed out after starting HRT? This side effect should be evaluated CAJASS: With regard to the bladder control and menopause, how is that treated? With hormones? With a bladder suspension? I am getting really bad. Dr. Marcie Richardson: HRT can sometimes help with bladder control as can Kegel exercises. Sometimes surgery is required. You should be evaluated by a good uro-gynecologist. This is an area where new techniques are improving outcomes; but you need to find someone who is aware of them. CAJASS: I am doing Kegel exercises as we speak. Profbmott: What would you say to a woman who does not want to take provera with Ogen because of the fear of depression and weight gain? How great is the risk of uterine cancer if a woman does not take provera with ogen? Dr. Marcie Richardson: Well, in the Pepi study, 30% of women had endometrial hyperplasia on unopposed estrogen. I think it was after one year, but perhaps it was three years. I would have yearly endometrial biopsies if I was taking Ogen alone. You could try taking progestins every three months. Profbmott: How many of the hyperplasias turn into cancer? Dr. Marcie Richardson: How many hyperplasias become cancer is uncertain; but it is though to be a pre-cancerous condition. Dearest: The log of Dr. Marcie Richardson's visit to Power Surge will be in the PS Reading Room in the next few days. E-mail me for details. Dearest: Marcie, thanks so very much for joining us in Power Surge tonight and fielding all our questions about menopause. Your giving of your leisure time to spend it with us is very much appreciated and a tremendous service to women in menopause everywhere. We all hope you will come back again very soon. Read another transcript with Dr. Marcie Richardson, Dr. Susan Love and Power Surge Founder, Alice Stamm Disclaimer: Every guest in Power Surge is a highly respected professional whose opinions are his/her own. An appearance in Power Surge does not constitute an endorsement of a guest's views. None of these transcripts may be reprinted or reproduced without the express permission of Power Surge™ and the respective guest. Read other transcripts by returning to the Library. Dearest aka Alice Stamm Power Surge Founder, Facilitator, Host Copyright©1994-2005 by Power Surge. All Rights Reserved.

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