Category Archives: Better Health Through Science

Alcohol, Women and the Economy

Alcohol abuse has ruined many lives and relationships. There are few families without these problems. Child abuse, partner abuse and self-abuse are all intertwined when it comes to the use of mind-changing substances. Some people are successful occasional users, many are not.

Recent research articles and experiences with alcoholic friends stimulated this series of blogs on the topic. This will be our last one for now, but I wanted to end with recent information on the topic to help you analyze your own behavior and possibly intervene when you see dangerous behavior occurring.
Microbreweries and small distilleries have become popular everywhere. Tasting a “flight” of either beer or hard liquor samples may put you over the safe driving blood alcohol limit of .08. A designated driver is essential. One in ten deaths among working-age Americans between the ages of 20-64 is caused by excessive alcohol. Drunk driving kills.

Two days ago, a report from the Centers for Disease Control and Prevention (CDC) released a study showing alcohol consumption and costs have accelerated. The economic costs are due to reduced work productivity, the cost of treating people for health problems related to alcohol, and crime. These statistics did not examine the pain and suffering from alcoholic behaviors.
We all understand why pregnant women must be wary of alcohol and its harm to an unborn child. Fetal Alcohol Syndrome, also called Fetal Alcohol Spectrum Disorder (FASD) is a constant reminder that mental and physical changes are attributable to a mother’s behavior while pregnant. There is no amount of alcohol consumed while pregnant that has been proven safe. The primary concern is that small amounts of alcohol could negatively affect the developing fetal brain. Each woman has to decide. Our advice to pregnant women is to wait and have a glass champagne to celebrate after the birth of your child.

Many have a glass of wine for social reasons. Others drink to get drunk, or are addicted and don’t stop until their blood alcohol level causes them to pass out. Tragedies happen every day due to alcohol. Think twice before you drink, and never drive after drinking.

Betty and Bev

I’ll Drink to That!

Some water flowing in high mountain streams is pristine enough to drink without the need of additives to kill or filter out disease-causing microbes. But, in many places on planet earth, water clean enough for consumption is in short supply. In California and other drought-ridden locations, plants and animals are dying due to insufficient water. In many areas around the world, dysentery from drinking contaminated water is prevalent and life-threatening.

We take water purity for granted in the US where chlorinated water pours from our taps. But, during much of the past 10,000 years, before the availability of pure water, the only safe liquid to drink contained alcohol. Today, we see alcohol through many lenses, with both good and bad views.

Alcohol is the metabolic byproduct of the natural process of fermentation that occurs when yeasts metabolize sugars. In the Middle Ages, alcohol was called “the water of life,” aqua vitae. They learned to make wine from grapes, and beer from fermented grain. People of all ages, including children, drank alcoholic beverages as their primary consumable liquid. The alcohol destroyed many microbes causing disease and made it safer to drink than water. The processes for making wine and beer are simple. Today, many people make them for fun. Microbreweries have sprung up everywhere. There are many suppliers, even health food stores carry the products.

All alcohols are not consumable. Some can cause blindness and death. Disinfectant alcohol is applied to surfaces of the body prior to medical procedures, and is the primary ingredient in liquid hand purifiers. Windshield cleaners spew various colored fluids containing alcohol. There are many industrial uses.

20150626_195841The drinkable form is ethyl alcohol. It is used in celebratory toasts, paired with elegant dining, and has been shown to contribute to cardiovascular health. Undisciplined drinking carries health risks and tragedy. Alcohol is a sedative drug and a toxin. Excessive consumption contributes to loss of mental function, also causing addiction and liver failure. Alcohol has become a common social drink and a problem for many who drink to excess.

Our next blog will review a new powdered alcohol product called palcohol. Additional blogs will provide information on health and social issues related to alcohol consumption, common early signs of problematic drinking, and will discuss blood alcohol determinations.

Here’s to safe drinking, designated drivers, and moderation in all things.

Betty and Bev

INFLUENZA UPDATE

Influenza is a respiratory illness caused by a virus.

In 1918 a deadly outbreak of influenza known as Spanish Flu occurred. The disease killed about 50 million people around the world. Recent research done on preserved lung tissue from people who died showed the lung damage seen with bacterial infections, not viral. Researchers concluded the Spanish Flu virus caused a severe respiratory illness, complicated by bacterial infection before effective antibiotics were available.

Seasonal flu remains a serious health problem carrying the greatest risk in older people and those with lung conditions such as asthma and chronic lung disease. Ninety percent of deaths occur in people over the age of sixty-five. A bacterial pneumonia is a common occurrence with influenza. The “pneumonia shot” only prevents one type of bacterial pneumonia, pneumococcal, and is recommended for adults 65 and older.

Today, each year in the US more than 36,000 people die and 200,000 are hospitalized with the flu. Anti-viral drugs are available and shorten symptomatic periods by a couple of days. Antibiotics reduce fatalities from complicated pneumonias that often follow influenza. Getting a “pneumonia shot” only prevents pneumococcal pneumonia.

Each year the flu vaccine is formulated to stimulate immunity to the influenza viruses most likely to be present in the upcoming season. The vaccine usually covers 3-4 different viruses. While the Centers of Disease Control and Prevention (CDC) researchers do their best to match the annual vaccine with the anticipated viruses, the vaccine may not prevent all influenza illnesses because the viruses mutate and change each year.

“The CDC notes that around 70% of this season’s H3N2 viruses have been identified as “drift variants” – viruses that possess antigenic or genetic changes that make them different from the virus included in this season’s flu vaccine, meaning the vaccine’s effectiveness is reduced.”

 “… the CDC estimates that the flu vaccine has reduced an individual’s risk of visiting a doctor due to flu by 23%. This result remained after accounting for patients’ age, sex, race/ethnicity, self-reported health and the number of days between illness onset and study enrollment.”

The best way to prevent the flu is to get your immunization every year. Once you have been immunized it takes about two weeks for the body to generate a response to prevent the disease.

“Despite the low effectiveness of the 2014-15 flu vaccine, the CDC continues to recommend that all people aged 6 months and older receive the vaccine, as it may still prevent infections from some circulating influenza A H3N2 viruses and reduce severe flu-related complications.”

What to do: To protect yourself from influenza, avoid people with respiratory illnesses, avoid hand shaking, use good hand washing technique and utilize alcohol hand purifiers. Early symptoms are typically muscle aching (myalgias), fever and worsening respiratory symptoms. Isolate yourself if you develop the symptoms. Antiviral drugs must be started within 48 hours of onset of symptoms to have benefit. Call you physician for advice if you are not improving or develop shortness of breath.

Best wishes for health and avoidance of influenza.

Betty Kuffel, MD

Broken Heart Syndrome

Takotsubo Cardiomyopathy

Losing a loved one, the sudden stress of receiving bad news, intense fear or domestic violence can break your heart. But this isn’t in the emotional sense we usually think about. There is an acute heart problem seen primarily in women of menopausal age in which the heart weakens in the face of sudden stress. The main pumping chamber of the heart balloons instead of contracts. Resulting chest pain and shortness of breath are symptoms indistinguishable from a heart attack.

The electrocardiogram shows classic ST segment elevation found in heart attacks. In addition, there is often a small sharp rise in troponin, a heart injury blood marker. In a typical heart attack caused by a blocked coronary artery, the damaged heart muscle cells leak troponin, but usually in larger amounts.

If an angiogram determines there is a blocked artery the cardiologist will likely place a stent. But in the broken heart syndrome known as Takotsubo Cardiomyopathy, instead of finding blockage, the coronary arteries are clear — the results indicate a failing heart with an odd shape. It looks like an octopus trap (a tako-tsubo).

 

The actual cause of this disorder is not known but is likely related to a surge of stress hormones that stun the heart and prevent normal muscle contraction. Takotsubo is usually seen in older estrogen-deficient menopausal women. However, younger women who lack estrogen because of surgical menopause from ovary removal are also at risk. Animal studies show estrogen appears to protect the heart in stress states.

There are no treatments shown to reverse Takotsubo. Doctors usually order common heart failure medications including beta blockers (to reduce heart rate and blood pressure), ACE inhibitors (to dilate arteries making it easier for the heart to pump) and diuretics (to remove excess fluid). It isn’t known if continuing the drugs can prevent a recurrence, but within two months, most patients fully recover. A few women are left with reduced heart function, and occasionally abnormal heart rhythms occur.

Women in this age group may also have underlying heart disease requiring medical management unrelated to the sudden stress state. Like men, women develop blockage of the major coronary arteries.

Another heart problem most often seen in women involves only small heart arteries. The large coronary arteries are clear but tiny arteriolar vessels are diseased. Microvascular disease is serious. It can lead to heart attacks and heart failure. A treadmill in combination with continuous monitoring, followed by echocardiogram to check heart function will show abnormalities. Microvascular disease is also treated medically.

Techniques used to help reduce stress hormone surges include: progressive muscle relaxation, exercise, yoga, avoiding alcohol and caffeine. Controlling anxiety is not easy and counseling may be necessary.

 

Lipstick Logic
Betty Kuffel, MD

Healthy Lifestyle – 2015

MAKING CHANGES IN THE NEW YEAR

Lifestyle means different things to different people. In the past, a healthy lifestyle for hardworking farmers meant getting up before dawn to first milk cows before spending a long day of heavy labor in the fields. A breakfast of fried pork chops and eggs accompanied by homemade bread slathered with butter commonly provided the first meal of the day. A hard working man needed those heavy calories for energy to perform his daily job.

Scan old photos and it’s unlikely you’ll find a fat farmer. They ate food laden with fat and calories but they worked it off. They earned their calories. My grandfather was a farmer. I saw what he ate. My family enjoyed amazing meals, especially during threshing when friends helped friends and families helped families. Eating well was their way of life. For most of us it’s the same today—except now, many people don’t earn their calories.

The body is an efficient metabolic machine. When you eat more calories than you burn your body stores the excess as fat. So lifestyle today is different from the lifestyle of the past, and practices of the past are unhealthy today.

Exercise is the single most important activity that correlates with a long and healthy life. A close second are: your food choices and the volume of food you eat. We need to eat to live, not live to eat.

A new twenty year-long study of 70,000 women confirmed a healthy lifestyle could prevent 75% of heart attacks in young women. Death rates from heart disease in the US have slowly dropped over the past four decades, but in women ages 35-44, this is not true. The study published in the American College of Cardiology reported health habits make the difference. Women with unhealthy lifestyle choices began showing increased heart risks by age 47.

Below are seven top ways to improve your lifestyle and reduce risks for heart disease:

• Don’t smoke
• Consume a maximum of one alcoholic drink/day
• Maintain a normal body mass index (BMI)
• Watch seven or fewer hours of TV per week
• Exercise at least 2.5 hours per week (35 minutes per day)
• Eat a quality diet based on Harvard’s School of Public Health healthy eating plate.
• Have an annual physical that includes a lipid panel

Smoking: Quit. Ask your doctor for assistance if you can’t do it on your own.
Alcohol: Wine: 5 ounces, Liquor: 1.5 ounces, Beer: 12 ounces
Plate and portions: Healthy Eating
BMI: At the link below you’ll find health information and a BMI calculator to check your current BMI. For the calculation you need to know your weight in pounds and height.
http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm

Make 2015 a healthy year for you and your family. Monitor your blood pressure, address your weight, add exercise every day and encourage others to do the same.

Betty Kuffel, MD and Bev Erickson

Lipstick Logic (TM)

LOVE YOUR HEART

Your Heart – Prevent and Reverse Heart Disease in Women, Men and Children

Kindle e-book $2.99   http://tinyurl.com/kindle-heart-sale          

Paperback $9.99  https://www.createspace.com/4330606

For the entire month of February, Your Heart is offered at sale rates.

American Heart Month is a perfect time to raise awareness and explore reversible risk factors for cardiovascular disease. Know your health history and address factors that can be modified to improve heart health:

♥ Tobacco use and cessation

♥ High blood pressure identification and treatment

♥ Cholesterol abnormalities paired with dietary modification and statin use when needed

♥ Obesity and diabetes with recommendations for normalizing weight and glucose

♥ Low activity levels counteracted with exercise prescriptions

♥ Alcohol consumption history and limitation of use

♥ Heredity factors and recommended interventions

Heart risk factors are within your ability to control. Make this the month you evaluate your personal risks and take action to reduce them. With the right knowledge and actions, the number one cause of death in women and men is preventable.

Book Excerpt:

Why is coronary artery disease the leading cause of death?

Atherosclerosis is a disease of affluence. In developed countries throughout the world where food is plentiful, coronary artery disease is the leading cause of death. We eat, not only because we feel hungry, we eat to pass time, we eat for enjoyment, and we munch mindlessly at social events. The fact is, we eat too much and it’s making us sick.

Coronary artery disease is tied to obesity. Food choices, portion sizes and exercise interplay, but the disease is more complex than any of these factors.

Statistics are boring to read and don’t mean much when they are without a face. But consider the fact that 50% of all people have high blood pressure, high cholesterol or smoke; all three factors cause heart disease. Many of us personally know someone with these problems. Is it you? A loved one? You have the ability to make healthy choices and improve your health by treating these factors.

Part of the high death rate from heart disease is due to a lack of education about the cause and what can be done to fight it. But even knowing sound health practices, many people do not follow them. In recent years, there has been a reduction in heart deaths through improved treatment, education and reduction of risk factors, but coronary artery disease still remains the leading cause of death.

Two programs to address education, diagnosis and treatment are: the Million Hearts initiative, developed by the Department of Health and Human Services, with a goal to prevent a million heart attacks and strokes by 2017; and the WISEWOMAN program, administered through the Centers for Disease Control and Prevention.

Heart disease is a huge problem in developed countries around the world, including the United States. The Million Hearts program joined with the US Centers for Disease Control and Prevention, the American Heart Association and other organizations. Together they share strategies to reduce heart risk factors and save lives. Information from these organizations is available for education programs to implement change.

At 21 US sites, the WISEWOMAN project provides a screening and evaluation program to help women obtain healthcare when they have little or no insurance. Examinations, laboratory tests and education to lower risks are included.

Diabetes, overweight, poor diet choices, low physical activity and excess alcohol are all issues placing people at risk. If any of these affect you, take control, read more, learn more and make heart healthy changes. Don’t become a statistic. Take action. Choose to reduce your personal risk factors.

According to the US Centers for Disease Control and Prevention, 50% of men and 64% of women who die suddenly of coronary heart disease have no previous symptoms. Even if you have no symptoms, you may still be at risk for heart disease.

Katie, a registered nurse who believed she was healthy, working full time in a hospital but having difficulty with an arthritic knee finally decided to see an orthopedist. He recommended a total knee replacement procedure. As part of her preoperative evaluation, her primary physician evaluated her and performed an electrocardiogram. The electrical tracing of her heart conduction and rhythm was abnormal, indicating ischemia. A special nuclear medicine test of her heart showed marked reduction of circulation in the heart muscle. Katie went directly to the heart cath lab where two main coronary arteries were found to be more than 90% blocked by cholesterol plaques. The cardiologist dilated and stented both arteries. The orthopedic surgery had to be placed on hold. — Katie denies ever having any symptoms related to her heart.

Many people are aware that high cholesterol is associated with heart attacks, yet have never had a cholesterol blood test done. Because they have no symptoms, they can’t believe they might be a candidate for a heart attack. The more you know how lifestyle, food choices and heredity factors impact heart health, the more equipped you will be to make healthy choices and obtain proper healthcare. This section provides more information on risk factors.

 Thanks for stopping by. We hope 2014 will be a healthy and happy year for you.

Betty and Bev

HEART DISEASE IN WOMEN

Go Red for Women – Wear Red on February 7th

In 2003, the American Heart Association began National Wear Red Day®. With so many women dying each year from heart disease, this movement was formed to bring attention to the problem. Their goal was to educate women and reduce this statistic.

 For the past ten years, each February, the Go Red for Women events have raised awareness and helped women make strides against heart disease. Fewer women are dying from coronary artery disease now, but it still remains the number one threat.

 In support of women’s heart health, Lipstick Logic is providing free excerpts and a sale on our book for the month of February.

 This is a perfect gift for yourself and those you love.

Your Heart – Prevent and Reverse Heart Disease in Women, Men and Children

Kindle e-book $2.99   http://tinyurl.com/kindle-heart-sale          

Paperback $9.99  https://www.createspace.com/4330606

  Your Heart Book Cover- Final FINAL

 Chapter 5

Female Heart Disease

Women and Heart Disease

Many women do not realize they are at high risk for heart disease and early death. Under age 50, heart attacks in women are twice as likely to be fatal as in men. Each year more than 250,000 women die of heart attacks. Six times the number of women die from heart disease than from breast cancer. Many factors weigh into these statistics including hormones.

♥ Research reported in the National Institutes of Health bulletin, The Heart Truth for Women, states that by leading a healthy lifestyle, women can lower risks by 82%. You are in charge. This means: regular exercise, healthy weight and not smoking. Also take medications to control other risk factors such as high blood pressure and high cholesterol. What you choose to do and what you eat can improve health and prolong life.

Coronary Microvascular Disease

Early in life, male and female hearts look alike and act the same. With aging, gender differences in disease processes become apparent and contribute to misdiagnosis in women. Men typically develop arterial heart disease that narrows large coronary arteries on the heart surface. Women have the same type of large vessel disease as men, but are also prone to coronary microvascular disease — a problem involving the small vessels called arterioles.

Possibly triggered by inflammatory disorders, coronary arterioles in women become stiff and unable to supply adequate oxygen to the heart muscle. Chest discomfort and other symptoms more subtle are often associated with increased activity. Microvascular disease increases your risk for heart attack and sudden death.

A number of health problems cause inflammation including high blood glucose, smoking and chronic infection that also affect men. Additional factors in women are: poorly controlled premenopausal hypertension, anemia and autoimmune disorders*. All of these problems may contribute to developing coronary microvascular disease. However, the cause of this disease is unknown. The Women’s Ischemia Syndrome Evaluation study (the WISE study) provided extensive information for the disorder. Some researchers believe estrogen reduction is a related. Anyone can develop coronary microvascular disease, but inflammatory disorders appear to be a prominent factor and they are more common in women.

Special tests are required to diagnose coronary microvascular disease. Advanced disease may be present, placing the person at risk, yet a coronary angiogram — the best diagnostic evaluation for large coronary arteries — can be normal. If the clinical suspicion for heart disease is high and the angiogram is normal, a “Stress-Echo” is usually recommended to evaluate for microvascular disease.

Coronary microvascular disease cannot be treated with stents or a bypass, but medications and lifestyle changes are beneficial and life-prolonging. Treatment is similar to that used in large vessel coronary disease:

● Statins to lower cholesterol

● Low dose aspirin to inhibit platelets

● Nitroglycerine to relax and dilate arterioles to improve blood flow and treat chest discomfort

● ACE inhibitors to lower blood pressure

● Beta blockers to lower heart rate and reduce heart stress

● Heart healthy diet, daily exercise, no smoking, weight loss

Note: Autoimmune diseases occur when the body produces harmful antibodies against itself. Examples: Lupus, rheumatoid arthritis, psoriatic arthritis, multiple sclerosis, some thyroid diseases and many others.

More life-saving information like this can be found in Your Heart: Prevent & Reverse Heart Disease in Women, Men & Children

Thanks for stopping by.

Betty Kuffel, MD

Bev Erickson Co-author/Artist/Cover art

Cardiovascular Disease – Leading Cause of Death related to Childbirth

Heart Disease in Young Women

 Statistics from the state of California confirmed the leading cause of death related to childbirth is cardiovascular disease:

                ♥1/4 of women who died had some form of cardiovascular disease

                ♥2/3 of the deaths were related to cardiomyopathy (heart muscle weakness)

Only 6% of these women had been diagnosed with a heart problem prior to pregnancy. (American Heart Association Scientific Session report)

We think of pregnant women as healthy vibrant individuals who do well and have healthy babies. But, pregnancy is a high risk condition for many reasons. Pregnancy places a large cardiovascular load on a woman’s body.

Young women without underlying heart disease are better prepared to tolerate the stress of pregnancy than older women. However many women are now delaying planned pregnancies until an older age when the potential for heart disease has increased.

Lifestyle, including food choices, alcohol consumption, and tobacco use all impact health during pregnancy. Obesity and Type 2 diabetes also increase risk to mother and infant. Cigarette smoking increases risk for sudden infant death and women who smoke are also more likely to suffer sudden death.

Two conditions often seen with pregnancy are: high blood pressure (pre-eclampsia) and diabetes (gestational diabetes). Both require careful monitoring and treatment Women with these problems during pregnancy are more likely to develop high blood pressure, diabetes and cardiovascular disease later in life.

Being overweight and pregnant places both mother and child at risk for cardiovascular disease and complications during delivery, including C-sections and anesthesia-related problems. Overweight pregnant women are more likely to have stillbirths, deliver prematurely and may have large infants making delivery difficult. Large babies are more likely to become obese in childhood.

Additional statistics: (From The American College of Obstetricians and Gynecologists)

  • Over one-third of women living in the US are obese
  • More than one-half of pregnant women are overweight or obese
  • 8% of reproductive-age women are extremely obese & at high risk for pregnancy complications

Guidelines for pregnancy weight gain are calculated based on the woman’s pre-pregnant BMI (Body Mass Index). Details are available on the American Congress of Obstetricians and Gynecologists website: www.acog.org  Search “Weight Gain During Pregnancy.”

 General guideline:

·         1.1 – 4.4 pounds in the first three months

·         1 pound/week during the last six months

·         The average total weight gain over all BMI ranges =  30 pounds

·         Low weight women: over 30 pounds may be acceptable

·         Obese women: gain only 11-20 pounds during the entire pregnancy

Nutrition counseling at all weights is very important to assure proper food choices and nutrition during pregnancy.

Before becoming pregnant, healthy choices, an active lifestyle (including daily exercise) and weight control are all important. Seek a full medical evaluation including laboratory studies before becoming pregnant. An exercise program and nutrition counseling will benefit mother and infant.

 

EXERCISE FOR LIFE

DSCF3133Fall is an invigorating time of year for many people. Even if you are not into fitness, it is a good time to start a plan. Walking in crisp fresh air, surrounded by evolving brilliant foliage colors, can help stimulate daily activity that will generate better health in years to come.

 A recently published medical study noted advanced planning can change the course of your life. Americans are living longer, but not always better. Our current life expectancy is seventy-eight, but with longer life more people are dealing with chronic diseases. So, the goal should be to begin modifying your risk base as soon as possible. Developing fitness in middle age, even if exercise was never a priority for you, reshapes your personal health landscape and can make later years more vibrant.

 In the longitudinal study of 18,000 people beginning in 1970, most of those who were the least fit at the time of their middle-aged checkup, had developed some of the following conditions early in the aging process: dementia, diabetes, heart disease and colon or lung cancer. Those who were most fit in their forties and fifties typically did not develop chronic illnesses until the final five years of their lives, instead of 10-20 years earlier like the less physically fit individuals.

 So if you look at the big picture, exercise is beneficial in delaying illness and living well in later years. Longevity without dementia is determined by genetics, fitness and staying involved mentally and socially. Even walking half an hour a day can improve your health.

 An article reviewing 45 studies, examining physical activity in people with cancer published in the Journal of the National Cancer Institute this year, emphasized the benefits of exercise. There was a decrease in all-cause mortality, including cancer-related death. Many of the studies examined involved women with breast cancer. With exercise, there are improved insulin levels, reduced inflammation and an increase in cells known to attack tumors.

 Muscle cells strengthen with exercise. Balance improves. But another important benefit is better blood flow to organs including the brain. In an animal study published in the journal Learning and Memory, fit animals not only showed improved memory, they generated new neurons in areas of the brain involved with learning.

 We all have many excuses for not being able to exercise. However, if you evaluate your interests and abilities, usually there is something to do to remain active, even if you have physical problems that interfere. Water exercises for individuals with joint and balance problems can increase muscle strength and be relaxing, too. If you have joint or back problems, consider riding a stationary bicycle for non-weight-bearing activity. Talk with your physician. Maybe a consultation with a physical therapist could set you on a course to improve muscle conditioning and your overall health.

If you say, “I’m too tired to exercise” consider this: studies have found exercise energized people, even those undergoing cancer treatments. Remember, exercise doesn’t have to be vigorous. Just taking a slow walk outdoors in the fall sunshine can brighten your day, increase bone-density to ward off osteoporosis, strengthen your muscles and help you live a longer healthier life.

Betty Kuffel, MD

POST-MENOPAUSAL HORMONE THERAPY IS BACK!

Low Dose Estradiol (bioidentical estrogen) and Dermal Patches Show Benefit

For those who have not experienced hot flashes or flushes, as they are sometimes called, they don’t sound like much of a problem. For most women, they aren’t. For me, someone who is often cold and wears wool socks to bed the year-round, it was a comfortable experience. I was warm enough for the first time in my life, except for experiencing the 108 degree temperatures on a Nevada desert.

The actual cause of vasomotor instability resulting from low estrogen is not fully understood and the problem is highly variable between women. Some are afflicted with numerous episodes each day associated with marked flushing, drenching sweats requiring clothing changes and faintness, while others barely notice the transition of waning hormones.

Women often seek medical care for hot flashes but it is the silent problems evolving without estrogen stimulation become important over time. Hot flashes tend to disappear while related heart disease and osteoporosis evolve causing problems in years to come.

Until about ten years ago, most women with menopausal symptoms were prescribed some form of hormone replacement. But results from the 2002 Women’s Health Initiative (WHI) and the Million Women Study (MWS) changed this practice. There was controversy and confusion among the experts, but in the end, the women lost when the consensus was that hormone replacement carried too much risk. The risks primarily included increased breast cancer, uterine cancer, strokes and blood clots.

Experts decided risks outweighed the benefits and recommended discontinuing hormone therapy. — Suddenly, hot flashes around the world contributed to global warming.

Breaking from the refusal to order hormone replacement for women, in June 2013 the British Menopause Society and Women’s Health Concern updated their guidelines. New recommendations are based on findings from a panel of experts that reanalyzed data from the WHI and MWS studies related to the specific hormones used. This time, when tracking the hormone options, they found low dose bioidentical estrogen, both oral and skin patch, carried less risk.

 Supporting Information

Another article just published in the Journal of the American Medical Association, JAMA, agrees with the use of bioidentical estrogen in hormonal replacement.  A joint University of Washington/Group Health study revealed women taking the generic estradiol had fewer vascular problems than those taking the equine estrogen preparation (Premarin). This difference may be related to clotting factors levels making blood clots more likely in women taking Premarin. Also the risk of having a heart attack was slightly higher in women using Premarin. No difference in stroke risk was seen.

Which Estrogen is Preferred?

There are many forms of estrogen and progesterone, both in oral, patch and cream forms. But estradiol is the same as that produced by the human ovaries. Premarin and other preparations are similar in effect but differ in chemical structure from estradiol. This new evaluation of the 2002 data showed the skin patch delivery of hormones appears most favorable.

 What About Other Risks?

Science evolves. Study outcomes change how we treat diseases. Hormone replacement surged from high utilization to stopping its use all together. Now the transition is back toward favorable aspects of low dose preparations. This is not to say, it is safe in all cases.

  • If you have had breast cancer, even the cell type without estrogen or progesterone receptors, you are probably not a candidate for hormones.
  • If you have had a stroke or venous blood clots in your legs or elsewhere, you would not likely be prescribed either estrogen or progesterone.

 The hormone progesterone is known to increase the risk of heart disease in women. Its use is to induce hormonal withdrawal bleeding and reduce the risk of uterine cancer in association with estrogen replacement in women who have a uterus. Estrogen can be used alone, without progesterone, following hysterectomy.

 If you are troubled with disabling hot flashes or marked bone loss (osteoporosis) you may be a candidate for estrogen replacement. You should discuss taking an FDA–approved bioidentical form of estrogen via skin patch with your physician.

 In my book, Your Heart – Prevent & Reverse Heart Disease, there is a chapter on women’s heart disease and the impact of menopause.  Additional favorable studies are noted reporting similar findings using low dose estrogen after menopause. One such study showed a significant reduction in heart disease with bone density improvements in women who took low dose estrogen.

 Note: “Bioidentical” is not the same as pharmacy-compounded estrogen products that are not standardized and may have variable potency.

 For more information on menopause check out: http://www.womenshealth.gov and my book at http://www.yourheartbook.com.

Betty Kuffel, MD

References:

SAGE Publications. Hormone replacement therapy: British Menopause Society and Women’s Health Concern release updated guidelines. ScienceDaily, 24 May 2013. Web. 2 Oct. 2013.

Nicholas L. Smith. Lower Risk of Cardiovascular Events in Postmenopausal Women Taking Oral Estradiol Compared With Oral Conjugated Equine Estrogens. JAMA Internal Medicine, 2013