There are several different types of progesterone used in hormone replacement therapy. Many are synthetic, such as levonorgestrel, medroxyprogesterone acetate (MPA), and norethindrone acetate. Currently, there are only two bio-identical progesterones known as micronized progesterone and prometrium. Synthetic progesterone-like compounds (progestins) were created because progesterone couldn’t be absorbed orally. Once progesterone was micronized (made into tiny crystals), it could be easily absorbed orally so synthetic compounds are no longer needed.  However, many physicians became used to prescribing synthetic compounds, so are continuing to use them.

Are the synthetics safe? Two major studies, the Women’s Health Initiative study and the Million Women study, have linked hormone therapy to breast cancer. Both of these studies used synthetic hormones. Their findings are echoed by a more recent study in France that showed a higher risk of breast cancer with progestin use, a small risk of breast cancer when using estrogen only (but an increased risk of endometrial hyperplasia-the thickening of the lining of the uterus which can turn into endometrial cancer) and no risk of breast cancer when using micronized progesterone. Two major studies, the Women’s Health Initiative study and the Million Women study, have linked hormone therapy to breast cancer. Both of these studies used synthetic hormones; their findings are echoed by the more recent findings in France.

So what does this mean to you? If you have a uterus, don’t use estrogen without progesterone to prevent endometrial hyperplasia and in turn endometrial cancer. When you use progesterone, make sure you are using micronized progesterone, not progestins. How can you tell if you are using progestins or progesterone? If your prescription says “progesterone” or “prometrium” it is bio-identical. If your prescription says  “progestin”, “prempro”, “provera”, “Medroxyprogesterone acetate ” or some other chemical name, it is not bioidentical. The progestin found in birth control pills is not bio-identical, but sometimes the benefits of a medication outweigh the risks. Talk to your provider for more information.

Women have believed for years that having a monthly period was a necessity, not an option. Today, researchers have discovered that we no longer have to put up with this monthly annoyance. According to professors of obstetrics and gynecology at the University of Washington, the purpose of a period is to get ready for pregnancy. If you’re not trying to get pregnant, then you’re not going to get a lot of benefit from a period. Women do not store up blood that needs to be shed every month and we certainly don’t “clean ourselves out” by having a period. These are old wives tales.

Researchers speculate that women today will menstruate about 450 times during their lifetime. Compare that to our ancestors, who were either pregnant or nursing most of their reproductive lives and who only had about 160 periods. The high number of periods women have today might be blamed, at least in part, for a breast cancer risk that’s as much as 100 times higher than the one pre-agricultural women had. The reason is because each time you have a cycle you send large pulses of estrogen throughout the body, particularly to the breast and ovaries, telling cells to divide rapidly. The more divisions that occur, the greater the risk is that something will go wrong and the “shut-off” signal that tells the cells to stop dividing will get stuck in the on position. The result: cancer.

Let’s look at the mechanics of menstruation. In order to have a period, you have to ovulate (release an egg from your ovaries) every month. That’s why when you’re pregnant, you no longer have periods. When you ovulate, you release hormones that stimulate the lining of the uterus and prepare it for pregnancy. If you don’t get pregnant, you shed the lining. So what if you didn’t ever stimulate the lining? You would’nt have  a period. That’s what birth control pills do- they block ovulation and prevent the lining from being able to support a pregnancy.

Now you’re asking yourself “Wait a minute, why do women on birth control pills have periods?” Remember, you have to ovulate to have a cycle and birth control pills block ovulation. So, where is the bleeding coming from? It’s a fake period. Yes, you read that right- a fake period. It’s actually a drug withdrawal from stopping the medication. It’s not even a real period. So why have one? A panel of researchers got together and decided that women would be really alarmed and confused if they didn’t have a period every month. That’s why the sugar pills were added to the birth control pill packs.

There are no long term side effects of skipping periods, in fact there are several benefits, including a decreased risk of ovarian cancer. There are several methods of eliminating periods. You can use birth control continuously if you are still considering having more children. If you are done with child-bearing, you might be interested in an endometrial ablation (NovaSure procedure) or a hysterectomy. If you want further information, schedule an appointment with your provider to discuss options.

We all know smoking is bad for us…but it’s not easy to stop. There is help if you are ready to quit. The FDA has approved a drug called Chantix to help stop smoking. Many people feel a sense of calm or relief when they smoke, Chantix blocks that feeling so there are no positive feelings associated with smoking. It also lessens the symptoms of withdrawl, making it easier for a person to quit.

Chantix is a capsule you take daily. The recommended dosing is:

• 0.5mg daily for days 1-3
• 0.5mg twice daily for days 4-7
• 1mg twice daily for weeks 2-12
• If another course is needed, you can continue the 1mg twice daily for the next 12 weeks

Does it work?

Several studies have shown Chantix to be more effective than Zyban (another name for Wellbutrin), which is more effective than placebos or no assistance. Some numbers from one of the studies:

• 44% of those on Chantix were not smoking at 12 weeks
• 29.5% of those on Zyban were not smoking at 12 weeks
• 18% of those on a placebo were not smoking at 12 weeks

Another study followed the participants who had quit smoking after 12 weeks on Chantix. Half of the group continued taking Chantix for another 12 weeks, half took a placebo. At the end of the 24 week period, 70.5% of those on Chantix were still not smoking, 49.6% of those on placebo were still not smoking. Obviously, Chantix is not a “silver bullet”, it doesn’t guarantee success. But, people trying to quit smoking have had more success taking Chantix than the other typical cessation aids.

Chantix can cause some side effects…the most common are:

• nausea
• insomnia
• headache
• abnormal dreams
• abdominal pain
• fatigue
• flatulence
• dry mouth

The most common side effect we hear about from patients is nausea with the pills. An effective way to deal with that is to drink 8 oz. water, take your pill with another 8 oz. of water, and then drink another 8 oz. water. The large amount of water seems to cut down on the nausea. The nausea typically passes after the first few weeks and patients have found it gets easier and easier to be a non-smoker.

What is cholesterol?

Cholesterol is a type of fat that has good and bad effects on your body. It is used to make hormones and nerve cells. However, when your body has too much cholesterol, the excess is deposited on the inside of blood vessel walls (called plaque). This blocks the passage of blood and can lead to heart attacks and strokes. Most of the cholesterol in your body is made by your liver from the food you eat.

Lets break down the components of cholesterol:

HDL (high-density lipoproteins) clean artery walls and remove excess cholesterol from the body. This is what is commonly referred to as “good cholesterol” (think of “H” for healthy cholesterol).

LDL (low-density lipoproteins) leave fatty deposits behind on your arterial walls contributing to heart disease (think of “L” for lousy cholesterol).

Triglycerides are a form of fat that the body makes from sugar, alcohol, and excess calories. It is carried through the bloodstream by your LDL to be stored in tissues (that spare tire is a prime example). Most of the body’s fat tissue is in the form of triglycerides, stored for use as energy.

What should my cholesterol levels be?

Cholesterol is checked with a fasting blood draw. “Fasting” means nothing to eat for 12 hours before the blood draw (don’t fast longer than 14 hours) and no alcohol for 72 hours before. Always drink plenty of water, though.

• Total cholesterol should be below 200
• HDL should be 40-60 to help lower your risk for heart disease
• LDL should be below 100 ideally…if you have diabetes, it is especially important to control LDL
• Triglycerides should be below 150

How can I control my cholesterol?

There are a few very effective things you can do to keep your cholesterol at healthy levels.

1. Limit the amount of fat and cholesterol in your diet. Nuts and high fiber foods (especially fresh fruits and vegetables) are excellent cholesterol controllers. Eating nuts raises your HDL levels and fiber will help lower LDL levels.
2.  Exercise! Just 30 minutes of moderate aerobic exercise daily will work wonders in your body. It keeps your weight down, decreases LDL levles, increases HDL levels and is a great stress reliever.
3. Stop smoking! Smoking increases your risk of heart disease because it lowers HDL levels.

Ask your provider if you have any other questions or concerns about cholesterol.

Uterine fibroids are growths that develop from the muscle cells of the uterus. They are almost always benign and most will cause no symptoms at all. They can range in size from small, pea-sized to more than 5-6 inches across. Not much is known about the causes of fibroids, but excessive levels of estrogen seems to increase their growth. When symptoms are present, they often include: increased menstrual bleeding, cramps, break-through bleeding, pain in abdomen or lower back, pain during intercourse, frequent urination, constipation, miscarriages or infertility.

How are fibroids diagnosed? If your provider suspects fibroids, they may order a pelvic ultrasound-which uses sound waves to create a picture of the uterus, or a hysteroscopy-which uses a device inserted in through the vagina to help the doctor see inside of the uterus. Other tests that must be done in a hospital setting are the hysterosalpingography- which is a special xray test, the laparoscopy- which uses a device inserted through the abdomen to help the doctor visualize the outside of the uterus, and MRI or CT scans.

How are fibroids treated? If your fibroid isn’t causing any symptoms, they most likely won’t require treatment. Some signs and symptoms may warrant treatment, such as:

• heavy or painful menstrual periods
• bleeding between periods
• uncertainty whether the growth is a fibroid or a tumor
• rapid increase in growth of the fibroid
• infertility
• pelvic pain

Fibroids may be removed surgically (myomectomy) which would allow you to keep your uterus if you are still wanting children, but may require you to have a cesearean for any future pregnancies. The fibroids will probably develop again after the procedure. A hysterectomy will get rid of fibroids permanently. If you suspect that you have fibroids, set up an appointment with your provider to go over your options.

It has been said that the only sure things in life are death and taxes. For women, you can add menopause to that list. Every woman will experience menopause…for some it is a small speed bump in life; for others it’s more of a slow, miserable experience that affects every aspect of their lives. Think you know about menopause and the effects it has on women? Here’s a quick list of menopause terms you should know…

• Premenopausal-Normal adult life, having periods monthly.
• Perimenopausal-your ovaries start producing less estrogen, causing symptoms such as: hot flashes, mood swings, difficulty sleeping, decreased libido, and fatigue.
• Menopausal-ovaries stop functioning, menstruation ends, and symptoms will get worse as your body tries to adjust. Once you’ve stopped bleeding for an entire year, you know you’ve gone through menopause.
• Postmenopausal-Periods have stopped, symptoms are better…you can look forward to the rest of your life!
• Premature menopause-menopause starting before age 40.
• Surgical or induced menopause-menopause caused by surgical removal of or by damage to the ovaries. Not the natural progression.
• Hot flashes-sudden wave of mild to intense body heat caused by decreasing levels of estrogen
• Night sweats-severe hot flashes that occur at night drenching you in sweat
• Insomnia-inability to fall asleep or remain asleep…a common occurance during menopause
• Libido-the sex drive. As women progress through menopause, often the libido decreases. Most of this decrease can be attributed to the effects of hormone imbalance and the symptoms caused by the imbalance.
• LH and FSH-luteinizing hormone and follicle-stimulating hormone are blood serum tests used to evaluate pituitary function and fertility. These hormone levels will rise during menopause as your body tries to stimulate your remaining eggs to mature.

There are many signs and symptoms of menopause…and it’s different for each woman. Keep the lines of communication with your provider open, and together the two of you can create a plan for dealing with your symptoms as they arise. Menopause doesn’t have to be a miserable experience.