In the most recent issue of Obstetrics & Gynecology, Jan Shifren and Isaac Schiff reviewed the literature about the use of hormone therapy (HT) in the menopause. The principle indication for hormone therapy remains the treatment of hot flushes and night sweats. Benefits generally outweigh the risks for healthy women with bothersome symptoms who elect to HT at the time of menopause. Although hormone therapy increases the risk of coronary heart disease, recent analyses confirm that this increased risk occurs primarily in older women and those a number of years beyond menopause. These findings do not support a role for HT in the prevention of heart disease but provide reassurance regarding the safety of use for hot flushes and night sweats in otherwise healthy women at this difficult time of life. An increased risk of breast cancer with extended use is another reason short-term  treatment is advised.

Hormone therapy prevents and treats osteoporosis but is rarely used solely for this indication. Estrogen is as effective as the other treatments for osteoporosis, so most women using HT for menopausal symptoms will not need additional treatment for their bones except for adequate calcium and vitamin D intake. If only vaginal symptoms are present, low-dose local estrogen therapy is preferred. There are creams, pills, and an estrogen ring which can be used to treat vaginal symptoms. They are all equally effective and which is used may be based on the woman’s preference. The risk profile for vaginal therapy is very different from systemic therapies, and there is no data that suggests a link between use of vaginal estrogen and the development of breast cancer or heart disease. There are safety studies up to 1 year showing no adverse endometrial effects, but studies of long-term effects of low-dose vaginal estrogen therapy are lacking. Therefore, women using vaginal estrogen therapy should report any vaginal bleeding and should undergo thorough evaluation.

Contraindications to HT use include breast or endometrial cancer, cardiovascular disease, history of blood clots, and active liver disease. Alternatives to HT is advised for women with or at increased risk for these conditions. The lowest effective estrogen dose should be used for the shortest duration necessary. Women should be informed of the potential benefits as well as the risks of all therapeutic options. Care should be individualized, based on a woman’s medical history, needs, and preferences.

written by Charla Blacker, MD

It amuses me when I hear about studies trying to prove things that seem pretty obvious to me.  So when I read about a study led by Hilary A. Tindle, M.D. at the University of Pittsburgh which showed that women who were happy were healthier than those who weren’t, I just thought- Duh!    And then I thought that maybe being healthier makes you happier.  In any case, happy and healthy go together and and in case you need it there is scientific proof!

Women’s Health Initiative (WHI) followed 97,000 postmenopausal for more than 8 years and found that optimistic women had a lower rate of heart disease than those with higher levels of cynical hostility and mistrust.  In fact, cheerful women had a lower risk of dying from any cause.

This is not the first time optimism and better survival has been looked at.  A study published in the British Medical Journal last year found that optimistic women had a 25% less chance of breast cancer than pessimists.

Other studies have not found a link between optimism and survival rates but a positive outlook has been found to be linked to reduced pain and eased side effects of cancer treatments.

The whole mind-body connection has achieved much more attention in recent years.   Several books are available addressing the subject.  Leslee Kegan M.S., FNP from the Mind-Body Medical Institute at Harvard wrote a book and developed a whole program called Mind over Menopause.    Check out this link for her essay on the North American Menopause Society site-  http://www.menopause.org/positivepassage.aspx.   There are some great suggestions about getting into a positive frame of mind. 

 But if life is really getting you down and you are tending toward crotchity as you get older, what else can you do to put a smile on your face?   How about Laughter Yoga.  Just going to the web site and looking at the video will crack you up! Go to www.laughteryoga.org.

For the sake of your health find ways to cultivate your happiness.  As  Abraham Lincoln himself once said-” Most folks are about as happy as they make up their minds to be.”

written by Deborah McBain, CNM MSN \\ tags: mind-body medicine

Would you consider paying to allow someone to poke needles in your body?  No?  What if I told you that the result may be less hot flashes, better sleep, return of sex drive and more energy?  Got your attention?  Well,  then read on about acupuncture.

Acupuncture has been around for about 5,000 years.  Very thin “needles” are placed in key areas of the body called meridians to stimulate and balance the flow of energy through the body.  It has been used by an estimated 8.2 million U.S. adults.  Benefits have been published in peer-reviewed western medical literature and studies conducted by the National Institutes of Health

Acupuncture is often used in combination with Chinese herbal medicine and referred to as Traditional Chinese Medicine (TCM).  Increasingly TCM and other alternative health modalities such as mind/body therapy and massage is being combined with conventional ( allopathic) western medicine to achieve enhanced results.  Referred to as Integrative Medicine it is hoped, by practitioners in both camps, to bring the best of both worlds together.  TCM is being used for various women’s health issues such as menopausal symptoms,  cancer support, emotional health issues and chronic disease management.  All issues close to the hearts of many of us of a certain age.

In 2008 Henry Ford Health System oncologist, Dr. Eleanor Walker with the assistance of  acupuncturist, Beth Kohn conducted a study with 47 breast cancer patients.  These patients were all on tamoxifen or Arimidex to reduce cancer recurrence.   Hot flashes are a common side effect of these two drugs.  Half of the women received acupuncture treatment and half were given the antidepressant venlafaxine (Effexor).  Effexor has also been shown to reduce hot flashes.  At the end of 12 weeks both groups reported 50-75%  fewer hot flashes.  The acupuncture group reported no side effect and other improvements such as  improved sense of well being, more energy and higher sex drive.  The antidepressant group did not experience these benefits.

This is useful information to those of us who may be struggling with menopausal symptoms but do not want the side effects of hormone therapy or antidepressants.  Although most health insurance companies do not cover the cost of acupuncture, it is eligible for reimbursement from a health care  flexible spending account.  Many large health care organizations around the country have Integrative Medicine Centers were you can be assured of getting well trained, reliable practitioners.  If you are interested in more information and live in  southeastern Michigan, contact Henry Ford Center for Integrative Medicine  at 248-380-6201.  Tell them you are “poking around” for some answers.

written by Deborah McBain, CNM MSN

I know that summer has not officially begun, but you know how it goes.  Before you know it the leaves will be turning!  Again.  Don’t groan, you know it’s true.  But there is more to look forward to than cold weather.  Starting in September, Henry Ford Health System will be beginning a new series of Menopause Support Circles.  We will continue to offer them monthly at 4 different southeastern Michigan sites.  We have selected topics which our past participants have suggested so we know they will be of interest to you.  Take a gander below at what we will be covering at our fall meetings.  Enter the the dates in your Blackberry or scribble them into that little Hallmark calendar with the curled corners kept in the bottom of your purse but mark it somewhere so you don’t forget.   Attend any or all and be prepared to be informed, entertained, validated and fed.   Please RSVP at 1-800-HENRY- FORD.  For more information on meeting locations and specific dates, click meeting details on the left or go to Menopause Support Circles page.

September 2009

 Illuminating Elimination New approaches to pelvic problems. Learn about techniques and methods for managing and preventing bladder, bowel and prolapse problems. This is a talk that shouldn’t be missed.

October 2009

Taking Care of the Girls” : In honor of breast cancer awareness month, you will learn how to reduce your risk for breast cancer. Discussion will include the newest methods of detection in breast cancer and treatment options.

November 2009

Sizzle or Fizzle: Menopause and Sex: Your body is changing and so is your sex drive. Come join the discussion and have your questions answered about what is normal and what might be cause for concern.

written by Deborah McBain, CNM MSN

Who cannot be inspired by her story? Please join us if you can.  Dinner is included.  Below is press release with more details about this event.

On Wednesday, Dec. 3, Elizabeth Edwards brings her message of finding hope and inspiration in life’s challenges to the Troy Hilton, at 5500 Crooks Road. The Henry Ford Health System, Ford Motor Company and Metro Parent Magazine are proud to present this unique opportunity, entitled “An Evening with Elizabeth Edwards.”

The event is rescheduled from its original Wednesday, Oct. 15 date, which was cancelled due to Mrs. Edwards mother’s illness.

The country has gotten to know Elizabeth Edwards as she campaigned across the country during her husband’s political campaigns. The day after the general election in 2004, she was diagnosed with breast cancer. Mrs. Edwards was in remission until March 2007 when she discovered her cancer had returned. Her courageous battle with breast cancer has served as an inspiration to women across the country, which she shares in her memoir “Saving Graces: Finding Solace and Strength from Friends and Strangers.” A passionate supporter of children and families, as well as an accomplished attorney, she has been an advocate for many important causes.

One that is dearest to her heart is the Wade Edwards Foundation. The foundation, which helps finance educational and enrichment programs for young people, is named after Mrs. Edwards’ eldest child, Wade, who tragically died in a car accident in 1996 at the age of 16. Mrs. Edwards is the proud mother of three other children: Catharine, Emma Claire and Jack.

Despite a battle with breast cancer, the loss of a son and the pressures of living a life in the public eye, Mrs. Edwards has remained determined to live what she calls “an inspired life.” Mrs. Edwards will share her story of how she’s persevered through tough times. “An Evening with Elizabeth Edwards” is sure to be an uplifting and inspiring event for anyone who is or has experienced difficulty in their lives, especially those affected by breast cancer.

“An Evening with Elizabeth Edwards,” will be held at the Troy Hilton in Troy, Mich. General admission tickets cost $25.

The event is presented by Henry Ford Health System, Ford Motor Company and Metro Parent Magazine. It is sponsored by the Michigan Education Savings Plan (MESP), Magic 105.1 and Inforum.

To purchase tickets or for additional information, visit MetroParentEvents.com or call 248-398-3400, ext. 128.

SOURCE Metro Parent Magazine

MetroParentEvents.com

written by Deborah McBain, CNM MSN

This month’s Menopause Support Group meeting is Wednesday October 15.  Topic is -”Taking Care of the Girls- Reducing Breast Cancer Risk”

Who doesn’t know that October is Breast Cancer Awareness Month?  This is a disease that has about the best media coverage and public relations promotions of any disease I can think of.   I read an opinion that this is because there are so many breast cancer survivors who have a lot of energy after their treatment to promote awareness.  This is unlike, say lung cancer, which actually kills more women but leaves less survivors.  I think it may also be because in the past breast cancer truly was always a death sentence and  still carries the lingering emotions of that terror.  Survivors feel touched by death.

I personally felt that terror after being diagnosed with breast cancer last year.  A very small non-invasive cancer was discovered in my left breast after a routine mammogram.  No lump, no family history but there it was.  If I had known at the time how easy the lumpectomy and radiation therapy would be, I would not have been so terrified.  But I can tell you now, it turned out not to be a big deal for me.  I was lucky.  I did not need chemotherapy.  I have survived some difficult things in my life, but I do not feel like a “breast cancer survivor”.    A survivor is someone who has endured catastophe, like a hurricane or a life threatening disease.  My disease got no where near life threatening.  It is not at all likely that I will die from breast cancer.

I am one of a growing number of women whose disease was caught so early that it is not the monster it used to be.  We can thank technology for that.   That includes access to regular mammograms and better mammograms, better scientific knowledge about the disease and how to treat it.  Key, too is a growing knowledge about how to prevent  breast cancer.   A generation ago breast cancer meant little choice but to have one’s breast loped off and weeks of debilitating treatments and more often than now, death.  Now with early detection, it is possible to come through it with little more than a barely visable scar.  With changes in life-style it may be prevented and many women will be spared.  We each have the power to fight this disease with education about prevention and early detection.

I honor my sisters who have battled life threatening breast cancer and have survived or succumbed.  I look forward to the next step in the battle in which someday the disease may be extinguished by a vaccine.  And I honor all of you who have survived all the battles of life- death of loved ones, lost jobs, diabetes, heart disease, lupus, other cancers and so on.  As Gilda Radner’s Rosanna Rosanadanna (who died of ovarian cancer) said, “It’s always something.” So I urge you to keep surviving whatever it is you are surviving.  Continue to be brave and fight.  Get your annual mammograms- and eat healthy, get exercise, stop smoking, limit or stop alcohol use, manage your stress, lose weight if you need to and, gosh darnit just take good care of yourself!

What have you survived?  What advice do you have for someone going through a difficult time?

written by Deborah McBain, CNM MSN