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



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